25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body

Abstract

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

T-shaped pars plana scleral incision to remove large intraocular foreign body

“…Although PPV brought novelty and safety to IOFB extrapolation, nowadays there is no consensus on a standard technique (28). Sborgia et al have shown that sutureless 25-gauge pars plana vitrectomy may be useful in the removal of IOFBs because it is associated with a less traumatic appearance, less conjunctival damage, less intraocular inflammation, and faster healing of sclerotomies compared with 20-gauge PPV (34). To our knowledge, there is no data comparing the 25-gauge to the 23-gauge system.…”

Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma

“…23,[65][66][67] Patients with traumatic endophthalmitis should be administered intravitreal antibiotics during surgery. [68][69][70][71][72] However, approximately 4% of patients still end up with eyeball atrophy, mostly caused by ciliary body damage induced by severe mechanical ocular trauma, recurrence of RD, or incomplete treatment of endophthalmitis. [73][74][75][76]…”

Comparing forceps and self-assembled intraocular rare earth magnet in removing metallic intraocular foreign bodies in 25-guage vitrectomy

“…In the past decades, pars plana vitrectomy(PPV) has been advocated and widely used in removing IOFB [ 6 , 7 ]. Comparing with external electromagnet, PPV provides a direct visualization and allows a timely management of vitreous hemorrhage and retinal detachment, which would result in better anatomic outcomes, visual prognosis and reduce the risk of endophthalmitis development [ 8 ].…”