We report a rare complication in which a foreign body was inadvertently left in the eye and the patient presented with a chronic red and sore eye. The foreign body was identified as a surgical needle in the superior anterior chamber, emerging from the conjunctiva superior to the limbus. The needle was removed surgically followed by a vitrectomy and removal of the dislocated intraocular lens. The patient has done well. Careful examination should be done and retained foreign bodies considered a differential diagnosis when patients present following surgery, especially when details of the surgery are missing.Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
JCRS Online Case Reports 2014; 2:71-72 Q 2014 ASCRS and ESCRSCataract surgery is the most common intraocular surgical procedure and has a low risk for complications. 1 Retained intraocular foreign bodies after cataract surgery are rare, with few documented reports in the literature. [2][3][4][5][6][7][8][9][10][11][12] We report an exceptionally rare complication following seemingly routine cataract surgery. It highlights the importance of an index of suspicion for retained intraocular foreign bodies when a patient presents with inflammation in the operated eye.
CASE REPORTA 72-year-old man was referred to our emergency clinic with a sore, red left eye. Cataract surgery had been performed elsewhere in that eye 5 months previously, but no surgical details were available. The right eye was unremarkable. Visual acuity was 6/6 and counting fingers (CF) in the right eye and left eye, respectively. On examination, the left eye had marked conjunctival injection, corneal edema, and inflammation in the anterior chamber. There was also a large superior iridectomy with superior displacement of the pupil, a dislocated intraocular lens (IOL) in the inferior vitreous, and a retained foreign body identified as a surgical needle in the superior anterior chamber (Figure 1, A) and emerging from the conjunctiva superior to the limbus (Figure 1, B). There was no attached suture.Surgery was performed. The conjunctiva around the needle area was opened, and the needle gently pulled out. A complete pars plana vitrectomy was performed, and the dislocated rigid poly(methyl methacrylate) IOL was removed. The corneal wound was closed with 10-0 nylon sutures. Intravitreal antibiotics were used prophylactically. The patient was left aphakic. At 4 months follow-up, the eye was quiet with a visual acuity of CF and a flat retina. Old keratic precipitates were present in the otherwise quiet eye. Macular edema was diagnosed and treated effectively with a tapered regimen of oral prednisolone starting at 40 mg daily. The visual acuity subsequently improved to 6/36 with aphakic correction. A secondary IOL implantation and pupilloplasty are planned.