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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 274-276

Anterior segment optical coherence tomography aided delineation of metallic intraocular foreign body


1 Comprehensive Fellow, Department of Comprehensive Ophthalmology, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
2 Cornea and Anterior Segment Services, KVC Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India
3 Cornea and Anterior Segment Services, KAR Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
4 Consultant Optometrist, KVC Campus, L V Prasad Eye Institute, Vijayawada, Andhra Pradesh, India

Date of Submission18-Jul-2020
Date of Acceptance09-Oct-2020
Date of Web Publication01-Apr-2021

Correspondence Address:
Dr. Sushank A Bhalerao
The Cornea Institute, L V Prasad Eye Institute, KVC Campus, Vijayawada - 521 134, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2327_20

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  Abstract 


Penetrating ocular injury is an important cause of loss of vision and may be associated with the presence of intraocular foreign body (IOFB). Missed IOFB may present with non-specific clinical features which may delay accurate diagnosis and proper management. We are presenting a case of unusual retained intraocular foreign body in a 38-year-old woman which emphasizes the need of careful review of patient's traumatic history and need of investigation like anterior segment optical coherence tomography (ASOCT) in diagnosis, localization of foreign body and follow-up after foreign body removal.

Keywords: Anterior segment optical coherence tomography, intraocular foreign body, penetrating ocular injury


How to cite this article:
Vuyyuru S, Bhalerao SA, Gogri PY, Reddy P, Mallipudi R. Anterior segment optical coherence tomography aided delineation of metallic intraocular foreign body. Indian J Ophthalmol Case Rep 2021;1:274-6

How to cite this URL:
Vuyyuru S, Bhalerao SA, Gogri PY, Reddy P, Mallipudi R. Anterior segment optical coherence tomography aided delineation of metallic intraocular foreign body. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Apr 11];1:274-6. Available from: https://www.ijoreports.in/text.asp?2021/1/2/274/312371



Penetrating ocular injury is an important cause of loss of vision and may be associated with the presence of intraocular foreign body (IOFB).[1] Missed IOFB may present with non-specific clinical features which may delay accurate diagnosis and proper management.[2] If the anterior chamber foreign body not removed in time, it could be embedded in angle of anterior chamber and wrapped by inflammatory membrane which may mimic idiopathic chronic iridocyclitis.[3] We are presenting a case of unusual retained intraocular foreign body in a 38-year-old woman which emphasizes the need of careful review of patient's traumatic history and need of investigation like anterior segment optical coherence tomography (ASOCT) in diagnosis, localization of foreign body and follow-up after foreign body removal.


  Case Report Top


A 38-year woman visited our hospital with complaints of redness, pain, watering and pricking sensation in left eye since two days after the accidental injury with needle while working with sewing machine at home. The patient signed a written informed consent that was approved by the local institutional review board which also specifies the consent to publish images related to the case.

At presentation, the visual acuity in her left eye was 20/40. The slit-lamp examination showed mild eyelid edema, ciliary congestion, self-sealed small vertical corneal tear of 1 mm size with endoexudate (vertical 1.6 mm × horizontal 1.8 mm) in the anterior chamber located at 5-6'0 clock position near the limbus with Seidel's test negative and normal pupillary reaction [Figure 1]. Fundus examination was within normal limits. B scan was also normal with attached retina and there was no evidence of any foreign body in posterior segment. We suspected a foreign body in anterior chamber and ASOCT was performed which showed self-sealed corneal tear [Figure 2]a and high anterior reflectivity with back shadowing in the angle of anterior chamber suggestive of foreign body in the inferior angle and surrounding moderate reflectivity suggestive of inflammatory membrane [Figure 2]b. Right eye anterior segment and fundus were essentially within normal limits.
Figure 1: (a and b) ciliary congestion, self-sealed small vertical corneal tear with endoexudate in the anterior chamber located at 5-6 '0 clock position near the limbuss

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Figure 2: (a) ASOCT showing self sealed corneal tear (yellow arrow). (b) ASOCT showing high anterior reflectivity with back shadowing in the angle of anterior chamber (foreign body - double headed yellow arrow) surrounded by exudative membrane (red arrow)

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Patient was scheduled for foreign body removal from anterior chamber under local anesthesia and during surgery we found that the needle was engulfed with exudative material and embedded in iris and surrounding tissue in inferior angle of anterior chamber which was masquerading as endoexudate on slit-lamp examination. The side port was made at 2'o clock and 0.5% intracameral pilocarpine was injected to constrict the pupil and protect the lens. The needle of 3.8 mm long with curved end with needle point size of approximately 1 mm [Figure 3] along with exudative membrane was removed from side port with the help of serrated micro forceps avoiding damage to Descemet's membrane-endothelium complex and exudative membrane was sent to microbiology for culture and sensitivity. The location from where the foreign body was removed and surrounding area was again checked for any residual foreign body with help of iris repositor. Side port was hydrated and intracameral moxifloxacin was given. Patient was given Inj. Tetanus toxoid 0.5 cc intramuscularly. She was started on empirical treatment with fortified Vancomycin 5% eye drop every hourly, Ciprofloxacin 0.3% eye drop every hourly, Atropine 1% eye drop thrice a day.
Figure 3: Needle removed from the angle of anterior chamber

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At 1-week visit, vision was 20/30 and slit-lamp examination showed mild ciliary congestion with small peripheral corneal macular scar [Figure 4]a. ASOCT showed cells in the anterior chamber and no scraps of IOFB [Figure 4]b. Culture reports of endoexudate were sterile. Patient was prescribed with Moxifloxacin 0.5% eye drop six times a day and carboxymethylcellulose 0.5% eye drop six times a day, Atropine 1% eye drop thrice a day for 2 weeks. At 2 weeks, patient visual acuity was improved to 20/20 with relief of symptoms and anterior chamber was also quiet [Figure 4]c.
Figure 4: (a) Diffuse illumination showing ciliary congestion with small peripheral macular corneal scar. (b) ASOCT of the left eye after removal of IOFB showed no retained scraps of IOFB, hyper reflective spots suggestive of AC cells (yellow circle). (c) ASOCT suggestive of quiet AC after 2 weeks of removal of FB

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  Discussion Top


Ocular trauma is the most common reason for emergency intervention in the ophthalmology and represents the second most common cause of loss of vision.[4] Intraocular foreign body (IOFB) account for 18 to 41% of all open-globe injuries.[1] IOFB may be responsible for variety of symptoms and signs based on its location, size and ballistics.[2] Missed IOFB in the anterior chamber angle could rub the corneal endothelial cells and may lead to corneal decompensation. It may cause release of iris pigments and may masquerade as chronic uveitis.[4]

Imaging like AS-OCT should be considered in patients in whom a FB is suspected in the cornea or in the AC to assess its location, size, and composition, to know the status of surrounding ocular structures, and to monitor the process of healing after surgical repair.[2] Reflectivity on ASOCT differs according to the type of foreign body. Glass foreign bodies are well delineated with no internal reflectivity, whereas foreign bodies of wood exhibit moderate internal reflectivity and those of metal exhibit high anterior reflectivity with shadowing.[5] AS-OCT image of our patient showed high anterior reflectivity with shadowing, indicating a metal fragment.

Anterior segment OCT imaging may also be used in detecting AC inflammatory reaction in uveitis which can be visualized as hyperreflective spots in AC[6] as evident in our case at 1-week post-operative visit.


  Conclusion Top


This case emphasizes the role of ASOCT in delineation, removal and follow-up after removal of non-clinically evident metallic intraocular foreign body involving anterior segment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

No authors have any proprietary interests in the contents included in this article. The contents of this article have not been presented in any national or international meeting.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Hyderabad Eye Institute and Hyderabad Eye Research Foundation.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mete G, Turgut Y, Osman A, Gülşen U, Hakan A. Anterior segment intraocular metallic foreign body causing chronic hypopyon uveitis. J Ophthalmic Inflamm Infect 2011;1:85-7.  Back to cited text no. 1
    
2.
Mahmoud A, Messaoud R, Abid F, Ksiaa I, Bouzayene M, Khairallah M. Anterior segment optical coherence tomography and retained vegetal intraocular foreign body masquerading as chronic anterior uveitis. J Ophthalmic Inflamm Infect 2017;7:13.  Back to cited text no. 2
    
3.
Huang YM, Yan H, Cai JH, Li HB. Removal of intraocular foreign body in anterior chamber angle with prism contact lens and 23-gauge foreign body forceps. Int J Ophthalmol 2017;10:749-53.  Back to cited text no. 3
    
4.
Wylegala E, Dobrowolski D, Nowińska A, Tarnawska D. Anterior segment optical coherence tomography in eye injuries. Graefes Arch Clin Exp Ophthalmol 2009;247:451-5.  Back to cited text no. 4
    
5.
Celebi AR, Kilavuzoglu AE, Altiparmak UE, Cosar CB, Ozkiris A. The role of anterior segment optical coherence tomography in the management of an intra-corneal foreign body. Springerplus 2016;5:1559.  Back to cited text no. 5
    
6.
Agarwal A, Ashokkumar D, Jacob S, Agarwal A, Saravanan Y. High-speed optical coherence tomography for imaging anterior chamber inflammatory reaction in uveitis: Clinical correlation and grading. Am J Ophthalmol 2009;147:413-6.e3.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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