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Purpose: To report a case of a child with strabismus and delayed discovery of a metallic intraocular foreign body with good recovery of visual acuity and stereopsis with 36-month follow-up., Methods: A 4-year-old girl was evaluated due to exotropia of right eye initiated 9 months before with progressive worsening. Visual acuity was 1.00 logMAR (20/200) in the right eye and 0.00 logMAR (20/20) in the left eye. Anterior segment evidenced a small paracentral corneal leukoma, posterior synechia and mild lens opacity in the temporal quadrant only in the right eye. Fundus examination in the right eye identified the presence of an intraocular foreign body, with appearance of metallic components surrounded by retinal pigmented endothelial cells atrophy. Full-field electroretinography (ERG) showed reduced amplitudes and delayed implicit times for both rods and cones in the affected eye. All tests were normal in the fellow eye., Results: Pars plana vitrectomy was promptly performed in the right eye, followed by phacoemulsification with intraocular lens implantation 4 months later due to worsening of the lens opacification. The full-field ERG was repeated after the surgical procedures. The ERG showed mild worsening of all responses in the right eye. After 36 months of follow-up, visual acuity was 0.20 logMAR (20/32) with improvement of the ocular misalignment and with 60 s of arc stereopsis with ERG responses unchanged., Conclusion: In this young girl perforating ocular trauma with metallic material was lately diagnosed with strabismus as a sign of alert. Prompt surgical intervention and proper management were essential to provide reasonable visual function including some degree of stereopsis, even though retinal dysfunction characterized by ERG was persistent.

Background: Although full-field electroretinogram (ffERG) is the gold standard test to detect physiological dysfunction in siderosis, it measures overall retinal function. This study aims to determine if multifocal electroretinogram (mfERG) can detect subclinical siderosis in eyes with an iron intraocular foreign body (IOFB)., Methods: Twenty eyes of 20 patients with retained iron IOFB, clear ocular media and good visual acuity (≥20/120) were enroled in this prospective case-control study. The fellow eyes served as control. These were evaluated with ffERG and mfERG at baseline. Serial mfERG was done till six months after pars plana vitrectomy with IOFB removal. Primary outcomes measures were amplitude and peak time of P1 and N1 wave of mfERG., Results: The median age was 25 years (range 18-55). Most patients (n = 14/20) presented within a month of trauma. Baseline ffERG showed no difference in either 'a' or 'b' wave amplitude or peak time between cases and controls. However, on mfERG, there was a significant decrease in P1 and N1 wave amplitude and delay in P1 wave peak time in <2° retinal ring in cases as compared to controls (p = 0.001, 0.001 and 0.02 respectively) despite variability in results. At 6 months, P1 amplitude showed significant improvement from baseline in cases (p = 0.010). However, P1 peak time did not show significant recovery (p = 0.65)., Conclusions: mfERG may reveal subclinical electrophysiological retinal dysfunction in eyes with iron IOFB in cases with normal ffERG. P1 peak time may serve as an electrophysiological marker for past retinal damage.

Purpose: To report new findings in a case of ocular siderosis explored by high resolution angiography and adaptive optics (AO)., Methods: We report data on a 40-year-old man with an intraocular foreign body (IOFB) embedded in the sclera after hammering., Results: Nine months after this accident, the patient presented with full-field electroretinogram (FF-ERG) abnormalities. Subsequent IOFB extraction was performed. One month after the surgery, high resolution angiography showed for the first time small iron particles all over the inner retinal surface. Spreading of these deposits was followed by inflammatory prepapillary new vessels and venous retinal vasculatis, which spontaneously resolved within a few months. ERG responses became slightly electronegative at this time. Clearance of the iron particles was followed over a year with AO and ERG recording. AO revealed an arterial tropism with a decrease in the amount of particles overtime, which may be consistent with macrophagic activity., Conclusion: High resolution angiography and AO are new tools, combined with electrophysiology, to better understand ocular siderosis pathophysiology.

Background: To evaluate and compare the perfluorocarbon liquid, silicone oil, and viscoelastic against standard saline, in their ability to dampen the impact force of a foreign body, dropped within the eye. In an experimental surgical model in where cohesive and adhesive forces of the substances are not enough to float heavy-than-water foreign bodies., Methods: A model of ophthalmic surgery was constructed. A BB pellet was dropped from 24 mm onto a force transducer through four different fluids: balanced salt solution, perfluoro-n-octane, viscoelastic, and silicone oil. The impact energy (force) for each case was measured and recorded by the force transducer. The mean force of impact for each fluid was compared using the Student t-test., Results: Silicone oil resulted in the lowest force of impact. Both silicone oil and viscoelastic dampened the impact an order of magnitude more than perfluoro-n-octane and balanced salt solution., Conclusions: Silicone oil and viscoelastic cushioned the force from a dropped BB. They may be useful adjuncts to prevent iatrogenic retinal injury during vitrectomy for intraocular foreign body removal., (© 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.)

Purpose: To assess the anatomical and visual outcome and also the retinal complications following vitreoretinal surgery for posterior segment intraocular foreign bodies (IOFBs)., Methods: Retrospective analysis of 59 IOFBs, with different locations within posterior segment,removed during pars plana vitrectomy (PPV) between January 1999 and January 2011, by the same surgeon, in Eye Clinic 1 Iasi. 47 out of 59 IOFBs (79.66%) were removed immediately after primary wound closure and 12 with a delay ranging from 48 hours to 5 years. All IOFBs were metallic. Total 20G pars plana vitrectomy with IOFB removal by forceps or intraocular magnet, careful membrane peeling and laser photocoagulation around the retinal injury (if present) was performed. Relaxing retinotomy was necessary in 3 cases of retinal incarceration. Endotamponade with SF6 (26 cases) or silicone oil (8 cases) were performed, if needed, at the end of surgery. The average follow-up period after surgery was 17.9 month (ranging 6 - 36 months)., Results: 18 out of 59 IOFBs (30.5%) were intraretinal. 39 out of 59 eyes (66.10%) showed signs of endophthalmitis at the time of surgery. Preoperative visual acuity ranged from light perception to 0.6. The mean visual acuity significantly increased after surgery from 0.16 preoperatively to 0.5 at the end of follow-up (range hand movements--1). 51 out of 59 cases (86.44%) had stable anatomical result. A final visual acuity equal or better than 0.1 was obtained in 45 cases (76.27%). Mild retinal folding could be noticed in some cases around the laser-treated retinal injury. In 8 out of 59 cases (13.56%) visual acuity remained low or decreased due to macular injury or PVR associated retinal detachment requiring additional surgery., Conclusions: IOFBs, and especially those intraretinal, require an early, complex and customized approach during PPV. Functional results do not match anatomical restoration if macula or optic nerve are impacted. Main postoperative complications were represented by retinal folds and PVR associated retinal detachment.

Purpose: To report the occurrence of a novel mechanism of IOFB with hot, liquefied glass injury., Methods: Retrospective case series., Results: Two patients suffered an injury to their eye with hot, liquefied glass. The ocular findings included a single scleral entry wound with multiple glass fragments located inside the eye. Fragments were found embedded in the retina, as well as mobile on the retinal surface., Conclusions: This distinctive mechanism involves an initial liquid state of glass causing injury, and results in multiple solidified glass IOFBs despite a single entrance wound. Though intraocular glass is typically inert, the unique characteristics of this injury may warrant a surgical approach. Surgical management proved successful in stabilizing vision and preventing further complications.

A 45-year-old woman underwent pars plana vitrectomy for vitreous hemorrhage in the right eye 20 years prior to presentation. She also had prior phacoemulsification and intraocular lens implantation and subsequent laser capsulotomy in the right eye. Multiple preretinal metallic fragments were visible on the retinal surface and were presumed to be stainless steel fragments from the vitrectomy instrument. The fragments were documented by color photography, fluorescein angiography, optical coherence tomography, and echography. Visual acuity was 20/30, electrophysiologic testing was normal, and no signs of toxicity were present. No surgical intervention was planned.

Background: Persisting metallic intraocular foreign bodies (IOFB) with a ferrous content have been associated with ocular siderosis and retinal degeneration. We describe two patients in whom a metallic IOFB containing iron was left embedded for many years in the choroid and sclera after having penetrated through the vitreous and the retina., History and Signs: Two male patients, aged 41 and 48 years, presented with a metallic IOFB sustained during a work accident involving metal tools., Therapy and Outcome: For the first patient it was deemed unwise to operate, as the IOFB was also lodged very deeply in the choroid and sclera in the inferior temporal quadrant. The second patient underwent pars plana vitrectomy, but the IOFB could not be removed surgically as it was too deeply embedded in the sclera and choroid. After a period of 6 years (Case 1) and 4 years (Case 2) of follow-up, visual acuity remained at 1.0 and the IOFB was encased in a fibrotic capsule in both cases. Full-field and multifocal electroretinograms showed an inter-ocular asymmetry at baseline, which remained stable during the follow-up., Conclusions: Ocular siderosis may not develop in patients with a deeply embedded metallic IOFB. Regular monitoring of both visual function and the electroretinogram is mandatory when the IOFB is left inside the eye.

Purpose: To identify the prognostic factors concerning the anatomy and visual acuity of eyes subject to trauma related posterior intraocular foreign body., Patients and Methods: The records of 28 eyes of 27 patients who underwent pars plana vitrectomy and intraocular foreign body removal during a 5 year period were retrospectively reviewed. Ocular trauma score was calculated for each eye., Results: The most common initial findings were corneal wound (68%), lens injury (50%), retinal lesion (50%), vitreous hemorrhage (25%), and endophthalmitis (14%). Multiple foreign body causing perforating injury with retained posterior segment foreign body occurred in 7% of the cases. The foreign body was found on the surface of the retina in 39% of the cases. Postoperative complications were retinal detachment (46%), proliferative vitreoretinopathy (25%), and phthysis (4%). No eye was enucleated and 1 eye (4%) lost light perception. The final best corrected visual acuity became better or equal to 0.5 Snellen E in 34% of the eyes. The mean follow-up was 19 months (1.5-60 months)., Conclusions: Prognosis was significantly worse in cases with lower trauma score, initial visual acuity less than 0.1 Snellen E, large foreign body, upset of bacterial endophthalmitis, and with proliferative vitreo-retinopathy. Visual outcomes in our cases were better than estimated follow-up visual acuity based on ocular trauma score parameters.

Introduction: Penetrating wounds to the eyeball with penetration of a foreign body at the posterior segment are often extremely serious for the eye. The equipment available to extract them can sometimes be inadequate., Observation: We report the case of a 38-year-old man hospitalized for a penetrating wound of the eyeball with a voluminous foreign body incarcerated in the retina. Because of the size of the foreign body it could not be extracted with the usual forceps. We describe the assembly put together during the intervention using an intramuscular needle and 7/0 virgin silk that allowed its extraction., Conclusion: This lasso provides a very effective, easy and nontraumatic grasp of voluminous foreign bodies in the vitreal cavity.

Background: A high rate of traumatic retinal injuries does not require a directed ocular fundus evaluation but those that deserve urgent care need it. The rate of traumatic retinal injuries that require urgent care was identified in order to learn whether there is a need of evaluating the ocular fundus in an emergency room., Methods: Patients with ocular trauma and ocular fundus evaluation who were referred to an Ophthalmology Service of a general hospital were included; patients with superficial foreign bodies were excluded. The rate of injuries that require urgent care (retinal detachment, intraocular foreign body) was identified and 95% confidence intervals (CI) were calculated., Results: One hundred fifty-three eyes of 148 patients (age 3-74 years, mean 26.4 years) were examined. Of 75 retinal injuries, 7 required urgent care (4.6%, 95% CI 1.3-7.9); the rate was 0.8% in closed globe trauma (95% CI 0-2.37) and 20.7 in open globe trauma (95% CI 5.9-35.5)., Conclusions: According to the rate of retinal injuries that would require urgent care in similar groups, in closed-globe trauma ocular fundus evaluation in the Emergency Room could be substituted by the evaluation of the fundus reflex; findings of any of these injuries in open-globe trauma does not modify the initial approach.

Background: To determine the outcome of surgery in patients who presented with posterior segment intraocular foreign bodies (IOFBs) and to identify factors associated with poor visual outcome. To assess whether improvement in vitreo-retinal surgical techniques over the past 17 years has resulted in an improvement in the outcome of these patients., Methods: A retrospective cohort study carried out at Moorfields Eye Hospital, London. Patients who underwent a primary surgical repair and removal of a posterior segment IOFB were identified using a hospital database. Of the 140 patients identified, 114 (81%) were included in the study. Data on age, activity at time of injury, presenting clinical features, surgical techniques, complications and final visual outcome were recorded and analyzed., Results: The mean age at time of injury was 34.6+/-12.4 years. All patients were male. The majority of IOFBs were metal (83%). Hammering and chiselling were the most common activities at the time of injury (66%). Fifty-three percent of patients presented with a visual acuity of 6/ 36 or better. Primary closure was achieved in a median of 1 day (interquartile range 1-3 days) following injury. A final visual outcome of 6/60 or worse was documented in 31%. Presentation with a relative afferent pupillary defect (P<0.001), hyphaema (P=0.024), vitreous haemorrhage (P=0.003), uveal prolapse (P=0.038) or retinal detachment (P=0.031) was associated with a poor visual outcome (6/60 or worse). Postoperative complications of retinal detachment (P<0.001) and proliferative vitreoretinopathy (P<0.001) were prognostic of poor final visual acuity. Improvements in surgical techniques, e.g. panoramic viewing systems has resulted in a significant improvement in the final visual outcome of these patients (P=0.043)., Conclusion: This large series of posterior segment IOFBs shows that recent advances in surgical techniques are associated with a significant improvement in prognosis.

Background and Objective: To describe potential clinical applications of optical coherence tomography (OCT) in diagnosis and surgical timing in eyes with posterior segment trauma., Patients and Methods: In a noncomparative study, 7 consecutive patients who had open-globe or closed-globe injury and were found to have posterior abnormality that could also be detected by OCT are described., Results: All patients had documented OCT abnormalities in the posterior segment. In one patient with a penetrating injury, two metal foreign bodies were located in the posterior segment, one in the vitreous compartment coupled with inflammatory reaction and localized posterior vitreous detachment and the other embedded in the retina. In a second patient with a penetrating injury, OCT revealed the appearance of posterior vitreous detachment 5 days after injury. A closed-globe injury in one patient resulted in anterior optic neuropathy, manifested as disc edema and thickening of the circumpapillary retinal nerve fiber layer. The other patients had received blunt trauma and were found to have either full-thickness macular holes (2 patients), retinal pigment epithelium detachment at the papillomacular bundle site (1 patient), or macular edema (1 patient)., Conclusions: OCT may serve as an important adjunct imaging device in evaluation of injuries to the posterior segment, qualitatively and quantitatively. It has potential in diagnosing subtle key abnormalities and in follow-up of these injuries.

Purpose: This retrospective study was undertaken to review the structure of patients that admitted to the hospital during one year, due to the different types of ocular trauma as well as to analyze the rate of the vitreo-retinal procedures being employed to treat those patients., Material and Methods: As many as 1212 consecutive patients (1252 eyes) submitting to the out-patients Department of Ophthalmology of the Medical University Hospital in Gdańsk between the 1st of January and the 30th of December 2004, presenting with eye injury were evaluated. The majority of the patients were males (746) with the mean age of 46.8 years. The females in the number of 466 were 48,5 years old in average. In 40 cases of ocular trauma both eyes were affected. The routine ophthalmologic examination was provided including the anamnesis and collecting the information regarding the circumstances of the injury. The ultrasound (USG) examination, fluorescein angiography (FA) and CT scan was provided when the intraocular foreign body (IOFB), the macular hole or uveal rupture were suspected., The Results: Most of the patients who admitted to the Clinic were applied the first aid and dismissed. That referred to 1210 of 1252 eyes. In 42 cases patients were hospitalized: 5 eyes received standard treatment while 37 eyes were operated. Twenty five eyes required vitreoretinal surgery - pars plana vitrectomy (PPV) due to the IOFB (6/25), vitreous hemorrhage (2/25), retinal detachment (10/25), dislocation of the lens (4/25) and the uveitis (3/25)., Conclusions: PPV revealed to be the most effective modality used for treating the most severe eye injuries. The analyze included the cases treated in one year time only, as the strategies of treatment tend to change in time as well as the techniques of operation. The time of observation was limited to 12 month additionally in purpose to make comparison easier in the different Polish centers surveys, regarding the treatment of mechanical eye injuries.

Purpose: To report a case of caterpillar setae embedded in the corneal stroma and inferotemporal retina with minimal inflammation., Design: Observational case report., Methods: A 4-year-old boy developed a red eye after playing with a caterpillar. He was placed on topical tobramycin/dexamethasone and referred for evaluation of embedded setae in his conjunctiva, cornea, iris, and retina. Examination revealed no iridocyclitis or vitritis., Results: Because of the lack of intraocular inflammatory response, no invasive intervention was conducted to remove or destroy the setae and he was tapered off the tobramycin/dexamethasone. At 4-month follow-up he remained asymptomatic with the setae still present in both his cornea and retina. In addition, vitreous membranes had formed in the immediate vicinity of the intraretinal setae., Conclusion: Intraretinal and corneal setae can be embedded with minimal inflammation and can be tolerated without need for surgical intervention.

Purpose: To report a case of siderosis from a retained intraocular iron foreign body manifesting localized retinal capillary nonperfusion documented by fluorescein angiography., Methods: Case Report. In a 35-year-old man with decreased vision in the left eye, studies included fundus photography, fluorescein angiography, visual field testing, and electrophysiology. Surgical foreign body extraction and histopathologic examination were performed., Results: Preoperatively, in the left eye, humphrey visual fields and electrophysiology testing revealed marked depression. Fluorescein angiography demonstrated nasal capillary nonperfusion with occlusion of the second- and third-order arterioles extending along a gradient from the foreign body. Microscopic examination of the lens capsule confirmed the diagnosis of siderosis secondary to a retained iron foreign body., Conclusion: Extensive capillary nonperfusion may be associated with a retained iron intraocular foreign body, as documented by fluorescein angiography.

Objective: To evaluate prognostic factors associated with final visual outcome, development of posttraumatic infectious endophthalmitis, and occurrence of proliferative vitreoretinopathy in patients with penetrating ocular injuries caused by intraocular or retrobulbar foreign bodies (FBs)., Design: Clinic-based cross-sectional study., Participants: One hundred thirty patients presenting with penetrating ocular injuries caused by lacerations from FBs were operated on by one of two surgeons between 1989 and 1997. Follow-up time was an average of 20.84 +/- 20.76 months (median: 17.0 months). All FBs were located posterior to the lens., Interventions: Pars plana vitrectomy; foreign body removal; additional surgical procedures according to the clinical situation., Main Outcome Measures: Postoperative visual acuity; posttraumatic infectious endophthalmitis; proliferative vitreoretinopathy., Results: Occurrence of posttraumatic infectious endophthalmitis developing in seven patients (7/130 = 5.4%) was significantly (P = 0.026) associated with removal of the FB later than 24 hours after the accident and with the type of the FB (P < 0.01). Size (P = 0.37) of the FB, preoperative visual acuity (P = 0.62), presence of traumatic cataract (P = 0.75) or a retinal lesion by the FB (P = 0.16), age (P = 0.39), and gender (P = 0.46) did not show a statistically significant influence on the occurrence of endophthalmitis. Statistically significant risk factors for the development of proliferative vitreoretinopathy occurring in 27 patients (27 of 99 [27.6%] patients with a minimal follow-up of 3 months) were size of the FB (P < 0.001), preoperative visual acuity (P = 0.02), presence of a retinal lesion (P = 0.002), and traumatic cataract (P = 0.03). The time between FB removal and the accident was statistically marginally associated with the development of proliferative vitreoretinopathy (P = 0.07). Postoperative visual acuity depended significantly on size of the FB (P = 0.002), preoperative visual acuity (P < 0.001), presence of a retinal lesion (P = 0.049), and location of the retinal lesion (P < 0.001). Three eyes had to be enucleated because of endophthalmitis or phthisis bulbi., Conclusions: Prognosis in open-globe injuries with intraocular or retrobulbar foreign bodies depends on the size and type of the foreign body, presence and location of retinal lacerations, additional involvement of other intraocular structures, preoperative visual acuity, and timing of surgery. These factors may be important in preoperative counseling of the patient and for planning surgery.

There are numerous unresolved issues and controversies regarding the management of open-globe injuries involving the posterior segment. These areas include, but are not limited to, the following issues. Although vitrectomy has been shown to improve visual outcomes and allow retention of the eye in many cases, the extent of visual improvement is often limited because of the nature of the injury. Timing of vitrectomy surgery has been and will continue to be debated by proponents of early versus delayed intervention. The multiple features of acute ocular injury make it very difficult to interpret retrospective data regarding the most appropriate timing for surgical intervention. The use of prophylactic cryotherapy, in the setting of a scleral laceration with possible retinal damage, is not as controversial at present, as there is now sufficient data indicating that cryotherapy may actually exacerbate intraocular proliferation and worsen the situation. The role and benefit of a prophylactic scleral buckle is very widely contested, and it is not known if it truly decreases the risk of subsequent retinal detachment. Another area of debate centers on the use of antibiotics. When there is a known clinical infection, intravitreal antibiotics are the mainstays of therapy. However, in the absence of clinical infection, the use of prophylactic antibiotics and their routes of administration are quite controversial. Although there are significant data regarding the use of antibiotics in the postoperative setting, this information cannot be extrapolated into the setting of open-globe injuries, as organisms and virulence factors differ. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved, although vitrectomy is used in most cases to repair concurrent damage from the injury itself. Finally, the placement of intraocular lenses in the acute trauma setting is controversial, as the risk of complications is quite high. Prospective, controlled clinical studies have not been done. This article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience.

Background: Penetrating ocular injuries with retained posterior segment foreign bodies are challenging cases requiring urgent attention by vitreoretinal surgeons. Posteriorly located injuries can result in serious immediate and delayed vitreoretinal sequelae, such as retinal detachment and endophthalmitis. We report our experience with posterior segment intraocular foreign bodies., Methods: We reviewed the records of all patients with penetrating ocular injury with retained intraocular foreign bodies treated at a university-based referral practice in Toronto between April 1981 and December 1995. We noted the pre- and postoperative Snellen visual acuity, type and volume of foreign body, diagnostic technique, surgical management, and pre- and postoperative complications., Results: Forty-one patients (all male with a mean age of 38 [range 8 to 78] years) were treated during the study period. The length of follow-up ranged from 1 to 118 (mean 20) months. Eighteen patients (44%) experienced a delay in diagnosis or management, or both, of 1 day to 3 years. The rates of retinal detachment and endophthalmitis were 41% (17/41) and 17% (7/41) respectively; culture gave positive results in 5 cases. Two of the eyes required enucleation. A final visual acuity of 6/60 or better was obtained in 33 eyes (80%) and of 6/12 or better in 21 eyes (51%). Multiple linear regression analysis showed that only immediate retinal detachment and the presence of a relative afferent pupillary defect had a significant independent effect on final visual acuity. In our previous series (1971-81) the retinal detachment rate was 14% (4/28), and there were no cases of culture-positive endophthalmitis; final visual acuities of 6/60 or better and of 6/12 or better were obtained in 46% and 32% of the eyes respectively., Interpretation: Reasons for the better outcomes in our more recent series may include improved localization of posterior segment foreign bodies with computed tomography, more frequent intravitreal surgery with improved vitrectomy techniques and the use of the intraocular magnet.

Purpose: To evaluate visual and surgical outcomes as well as complication rates after cataract extraction and primary intraocular lens (IOL) implantation during pars plana vitrectomy for removal of foreign bodies embedded or impacting in the retina., Methods: Six consecutive cases of simultaneous cataract extraction and IOL implantation combined with vitreous surgery and intraocular foreign body extraction were retrospectively analyzed. In five cases, the foreign body was intraretinal; in one case, it was preretinal with retinal impact site. The follow-up period ranged from 5 to 45 months (mean 21.3 months)., Results: Visual acuity improved by two or more lines in five of six eyes. In five eyes, best-corrected postoperative visual acuity was better than 20/40. One eye was successfully reoperated for retinal detachment that developed 2 months postoperatively. In four eyes, the IOL was implanted into the capsular bag; in two cases, the IOL was placed in the ciliary sulcus. No postoperative complication was attributed to IOL implantation., Conclusion: Primary IOL implantation after combined cataract and vitreoretinal surgery is a safe and attractive option, reducing the need for two separate operations in selected patients with penetrating ocular injury and retained intraocular foreign bodies. The main advantage is more rapid visual rehabilitation with a single operation, reducing costs and patient discomfort.

Purpose: To present an unusual case of a preretinal mass that simulated a retained metallic foreign body., Method: Case report., Results: A 30-year-old man presented with unilateral iridocyclitis and an ipsilateral preretinal mass with ultrasonographic and computed tomographic characteristics of a metallic foreign body. Histologic examination of the mass disclosed a central concentration of iron-containing hemoglobin breakdown products surrounded by a cocoon of fibrous tissue., Conclusion: Blood breakdown products surrounded by a fibrous capsule can present with the characteristics of an intraocular metallic foreign body.

Purpose: To report on a patient including measurements of retinal changes in ocular chalcosis., Patient and Methods: After having suffered an open-globe injury presumably due to a small foreign body after a grenade explosion, a 30-year-old man presented six years later with ocular chalcosis including sunflower cataract, a multitude of tiny brownish particles in the anterior vitreous, a fibrillar degeneration of the posterior vitreous and brilliant patches overriding the foveal region. The patches were measured by confocal scanning laser tomography (HRT) and optical coherence tomography (OCT)., Results: Besides an acquired cyandyschromatopsia, psychophysical and electrophysiologic tests were unremarkable. Vision was 20/20. The central patches measured 200 to 700 microns in diameter (HRT) and 150 to 200 microns in height above the inner retinal surface (HRT and OCT)., Discussion: With exception of a Kayser-Fleischer ring of the cornea the patient presents all morphologic signs of ocular chalcosis. Although the observed patches on the central retina in ocular chalcosis are described in the literature, their nature is not known.

Purpose: To describe the results of management of glass intraocular foreign bodies (IOFBs)., Methods: A total of 51 eyes of 43 patients that sustained penetrating injury with glass IOFB were studied retrospectively. A total of 23.5% had IOFB only in the anterior segment; the rest had IOFB in the posterior segment alone or in both the anterior and posterior segments. Six eyes were followed conservatively despite IOFB in a functional eye. Removal of IOFB was combined with repair of retinal detachment (where present) using internal tamponade with gas or silicone oil or buckle., Results: After a mean follow-up of 16.8 months, 66.7% of eyes recovered better than 6/60 (20/200) vision and 75.6% had attached retina. On univariate analysis, scleral entry wound, posterior segment IOFB, larger size of IOFB, and retinal damage were found to be associated with poor anatomic outcome. Lower presenting visual acuity, hyphema, retinal damage, subretinal hemorrhage, detached retina, and larger IOFB were associated with a poor functional result. Multivariate analysis identified retinal damage caused by the foreign body as the only factor significantly associated with poor anatomic as well as functional outcome., Conclusions: Glass IOFBs are caused in a majority of cases by blast injury. Bilaterality is not uncommon. Presence of retinal damage is predictive of poor functional and anatomic results. Overall results are modest with modern vitreoretinal surgical techniques.

A 27-year-old man who was a heroin addict had light flashes in front of the right eye and a hemicentral scotoma immediately after intravenous cocaine. The initial ophthalmoscopic appearance was of a white foreign body lying over the papillomacular bundle of the retina in the right eye. This ophthalmoscopic finding was consistent with intraocular talc, cornstarch, or lactose, common diluting agents that are present in intravenous injections of heroin, cocaine, or methylphenidate hydrochloride, and are known to cause systemic embolic phenomena in chronic drug abusers. This glistening crystal on the surface of the retina changed and evolved into a noninfectious but inflammatory organization of retinal granuloma, in which the foreign body crystal could still be visualized at the apex of the lesion. The anterior and posterior segments of the eye remained free of inflammatory signs throughout the course of the organization of the retinal granuloma.