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Protocol for removing intraocular foreign body likened to catching a killer

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Grazia Pertile

NEW ORLEANS — Removing an intraocular foreign body is much like capturing a killer, Grazia Pertile, MD, told colleagues at Retina Subspecialty Day preceding the American Academy of Ophthalmology meeting.

“Imagine a script with the title ‘The Capture of the Killer.’ The key steps would be to carefully evaluate the scene of the crime, choose the right instruments to approach the killer, prepare a safe way out after the capture, do not damage the surroundings during the action, and make sure the killer cannot escape after the capture,” she said.

When an intraocular foreign body is considered to be “the killer” in the scenario, then the key steps become the “perfect protocol” for its removal, she said.

First, carefully evaluate the condition of the globe using ophthalmoscopy, ultrasound, CT or rarely, when there is no chance that the foreign body is metal, MRI.

Second, choose the surgical setting for approaching the foreign body, for example, closed wound, bimanually, transcorneally or transsclerally, then choose appropriate instruments for the approach and shape of the foreign body.

Third, when planning a safe way out of the vitreous, “Make sure that you perform a careful peripheral vitrectomy before you remove a foreign body” to prevent retinal tears, Pertile said. “When considering the cornea, don’t use the cornea entry site to remove a foreign body” to prevent enlarging the wound.

Fourth, to prevent damaging the surrounding area of the retina, do not push the foreign body toward the retina to grasp it, she said: “Instead, use a pic to lift it up.” Regarding the anterior chamber, the corneal endothelium should be protected with viscoelastic material.

Finally, “Make sure the foreign body cannot escape,” she said. – by Patricia Nale, ELS

Reference:

Pertile G. Intraocular foreign body removal: Tips and tricks. Presented at AAO Subspecialty Days; Nov. 10-11, 2017; New Orleans.

Disclosure: Pertile reports no relevant financial disclosures.