Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies—epidemiology, pathogenesis, clinical signs, imaging and available treatment options

Casini, Giovanni; Sartini, Francesco; Loiudice, Pasquale; Benini, G; Menchini, Martina

doi:10.1007/s10633-020-09792-x

Cited by 30 publications

(23 citation statements)

References 126 publications

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“…BCVA after surgery was equal to or better than 20/32. When an IOFB cannot be found during ophthalmological evaluation, tools, including plain radiography, ultrasonography, ultrasound biomicroscopy, orbital computerized tomography scanning, magnetic resonance imaging, and optical coherence tomography, are available to aid in IOFB diagnosis [11,22]. Ultrasonography and computerized tomography are more sensitive methods for detecting all types of IOFBs [23].…”

Section: Discussionmentioning

confidence: 99%

“…Siderosis bulbi, one of the most serious complications, may be caused by retention of an iron-containing IOFB, which can cause deposition of iron molecules in the ocular tissues [9,10]. e clinical findings of siderosis bulbi include iris heterochromia, pupillary mydriasis, cataract formation, secondary glaucoma, retinal arteriolar narrowing, retinal pigmentary degeneration, optic disc swelling or hyperemia, and cystoid macular edema [9][10][11][12]. Without a complete examination, intralenticular foreign bodies (ILFBs) may be missed and therefore retained in patients with small self-sealing wounds who present with no decreased visual acuity [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

Wang

Qian

et al. 2021

Journal of Ophthalmology

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Purpose. Siderosis bulbi may occur as a result of retained intralenticular foreign bodies (ILFBs) that were missed during examination in patients with self-sealing wounds and without a significant decrease in visual acuity. This study aimed to explore the clinical characteristics and visual outcomes of ILFBs with self-sealing corneal penetrating wounds. Methods. Fifteen eyes of 15 patients with ILFBs and self-sealing corneal penetrating wounds, seen between October 2014 and September 2019, were retrospectively analyzed. Data regarding the patient demographics, clinical features, surgical procedure, and initial and final best-corrected visual acuity (BCVA) were analyzed. Results. All patients were male with a mean age of 41 years. The foreign bodies passed through the cornea, sometimes through the iris, through the anterior capsule, and finally localized in the lens. All ILFBs were pointed and metallic objects and were successfully removed with phacoemulsification and posterior chamber intraocular lens (IOL) implantation. Anterior capsule violation was found in three eyes, but no posterior capsule rupture was found. The IOL was placed in a capsule bag in all the cases. The BCVA ranged from 20/200 to 20/25 preoperatively and improved to between 20/32 and 20/20 at the last follow-up visit. The IOLs were well-centered. Apart from posterior capsule opacity in four eyes, no other postoperative complications were found. Conclusions. In patients with a pointed metallic ILFB and self-sealing corneal penetrating wounds (with or without cataracts), early diagnosis and removal of the metallic ILFB combined with lens removal and IOL implantation may avoid late complications and achieve good visual outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

Wang

Qian

et al. 2021

Journal of Ophthalmology

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“…ffERG is the gold standard for detecting retinal damage, such as toxic retinopathy and cone-rod dysfunction caused by iron IOFB, because it can reveal retinal dysfunction before any pathological changes. [ 12 ] Casini et al [ 13 ] mentioned that OS could be reversible and that ffERG amplitudes may increase after IOFB removal. We did not perform ffERG before the surgery; however, the postoperative ffERG showed decreased “b” and “a” waves 3 months after IOFB removal.…”

Section: Discussionmentioning

confidence: 99%

A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years

2021

Medicine

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Rationale: Intraocular foreign bodies (IOFBs) are common in ocular injuries, but asymptomatic metallic IOFBs retained in the anterior chamber for years are rare. Patient concerns: A 31-year-old female presented with blurred vision in her right eye after lumbar magnetic resonance imaging. Her best-corrected vision acuity was 0.6 in the right eye and 1.0 in the left eye. Slit-lamp examination revealed a brown granular foreign body in the anterior chamber and pigmentation of the limbus. Lens and retina examination indicated ocular siderosis. Corneal endothelioscopy revealed decreased endothelial cell density. A detailed history showed ocular globe injury 15 years earlier. Diagnoses: Anterior chamber IOFB with ocular siderosis. Interventions: Anterior chamber foreign body removal was performed with appropriate incision and forceps. Outcomes: The anterior chamber IOFB was successfully removed and examined as a magnetic metal foreign body. The best-corrected vision acuity was 1.0 at 1 day postoperatively. An abnormal electroretinogram with a 12% decrease in the “b” wave and a 91% decrease in the “a” wave was observed 3 months postoperatively. There were no intraoperative or postoperative complications during a 3-month follow-up. Lessons: Eye trauma should be examined carefully to exclude IOFBs. Asymptomatic anterior chamber foreign bodies can also cause corneal endothelial injury and ocular siderosis. Careful examination and timely management are needed in such cases.

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“…As a type of autogenic biological foreign body, the eyes’ reaction to cilium varies unpredictably. Whether cilia foreign bodies in the posterior segment have to be removed or not through an operation depends on the situation [ 10 ]. Intraocular cilium have been reported to be asymptomatic for 50 year in the anterior chamber [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma

Zha

Wang

et al. 2021

Med Sci Monit

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Background The aim of this study was to analyze the value of ocular endoscopy in detecting and extracting intraocular cilia in patients with ocular trauma. Material/Methods We retrospectively analyzed data on identification and extraction of 46 intraocular cilia in 16 eyes with open-globe injury during endoscope-assisted vitrectomy. Results A total of the 16 patients with open-globe injury were operated on from September 2002 to June 2019. The cornea in 14 eyes was cloudy. Two eyes had endophthalmitis and 13 eyes had retinal detachment. A total of 46 cilia were extracted through direct observation under the ocular endoscope during vitrectomy 1 to 68 weeks after injury. The number of cilia per eye varied from 1 to 10. Most of the cilia were located in or near the wound. Postoperative IOP was normal in 14 patients. The follow-up after surgery showed hypotony in only 2 eyes (7.2 and 5.8 mmHg, respectively). Compared with preoperative intraocular pressure, there was a statistically significant difference. The postoperative visual acuity improved in 12 eyes and remained unchanged in 3 eyes. The vision after surgery was significantly improved compared with that before surgery ( P =0.006). The intraocular pressure increased significantly after operation ( P <0.001). And no glaucoma or retinal detachment or endophthalmitis was found. No eyes needed additional vitreous surgery. Conclusions Ocular endoscopy allows surgeons to detect intraocular cilia that were no undetected by CT or B-ultrasound preoperatively in time and to extract them effectively. It improves performance of vitrectomy in the presence of a cloudy cornea and also prevents exogenous endophthalmitis. The vision of patients with ocular trauma was improved.

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Ocular siderosis: a misdiagnosed cause of visual loss due to ferrous intraocular foreign bodies—epidemiology, pathogenesis, clinical signs, imaging and available treatment options

Cited by 30 publications

References 126 publications

Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

Clinical Characteristics and Visual Outcomes in Patients with Intralenticular Foreign Bodies with Self-Sealing Corneal Penetrating Wounds

A rare asymptomatic metallic intraocular foreign body retained in the anterior chamber for 15 years

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma

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