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Michael Snyder MD
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A healthy 33 –year-old man with no prior ocular history was referred with a 6 week history of markedly reduced vision in his left eye. He did not recall the exact time of onset and specifically denied any ocular trauma. Slit lamp exam of the left eye showed a white and quiet globe with a clear cornea but a small 1mm, healed, shelved corneal laceration below the corneal dome with scarring of indeterminate age. Ultrasound biomicroscopy was performed, demonstrating an intralenticular foreign body near the posterior aspect of the 6.25mm thick lens.
Had we not known about the foreign body, unwitting intraocular maneuvers during the surgery, including the ultrasound encountering a piece of metal and sending it into the posterior segment, could have resulted in a less happy outcome. The ophthalmologist must be vigilant to watch for clues of injury, like penetrating scars, as in this case, or careful gonioscopy in cases of asymmetric cataract looking for angle recession, which may make us more alert to other pitfalls such as zonulopathy or post-op pressure rise.
Posted: 1/31/2014
Michael Snyder MD
A healthy 33 –year-old man with no prior ocular history was referred with a 6 week history of markedly reduced vision in his left eye. He did not recall the exact time of onset and specifically denied any ocular trauma. Slit lamp exam of the left eye showed a white and quiet globe with a clear cornea but a small 1mm, healed, shelved corneal laceration below the corneal dome with scarring of indeterminate age. Ultrasound biomicroscopy was performed, demonstrating an intralenticular foreign body near the posterior aspect of the 6.25mm thick lens.
Had we not known about the foreign body, unwitting intraocular maneuvers during the surgery, including the ultrasound encountering a piece of metal and sending it into the posterior segment, could have resulted in a less happy outcome. The ophthalmologist must be vigilant to watch for clues of injury, like penetrating scars, as in this case, or careful gonioscopy in cases of asymmetric cataract looking for angle recession, which may make us more alert to other pitfalls such as zonulopathy or post-op pressure rise.
Posted: 1/31/2014
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ari weitzner
11 years ago
no evidence of anterior capsule violation?
michael snyder
11 years ago
The only real evidence for the anterior capsule violation was the fact that there was capsule between the corneal scar and the foreign body within the lens. On exam in the office there was nothing that could be seen, even with careful scrutiny. If one looks carefully at the capsule after trypan blue staining, one can see a tiny linear area of reduced staining (just to the left of the outer perimeter of the capsulorhexis) which may represent the (amazingly sealed) entry point.