Extracting intraocular foreign body at or near the ciliary body with scleral indentation in direct visualization

Dear Editor,I＇m Dr. Qing-Huai Liu from Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University,Nanjing, China. I write to present four cases diagnosed with the intraocular foreign body （IOFB） at or near the ciliary body and to evaluate the effect of extracting IOFB with scleral indentation in direct visualization.

Removal of intraocular foreign body in anterior chamber angle with prism contact lens and 23-gauge foreign body forceps

AIM：To introduce a novel approach in removal of anterior chamber angle foreign body（ACFB） using a prism contact lens and 23-gauge foreign body forceps.METHODS：Data of 42 eyes of 42 patients who had undergone removal of ACFB using a prism contact lens and 23-gauge foreign body forceps from January 2008 to October 2013 were collected and analyzed. Twenty eyes in group A received the conventional approach by using toothed forceps through corneal limbus incision, and 22 eyes in group B underwent the novel method through the opposite corneal limbus incision. RESULTS：The success rate of ACFB once removal was 75%（15/20） in group A, and 100%（22/22） in group B. The average operation time of group A was significantly longer compared with group B（34.9±9.88 min vs 22.13±8.85min; P〈0.05）. The average size of corneal limbus incision in group A was significantly larger than that of group B（4.85±1.89 mm vs 3.95±1.17 mm; P〈0.05）. The corneal limbus incision suturing were conducted in all eyes in group A, and only 5 eyes in group B. CONCLUSION：Removal of ACFB using a prism contact lens and 23-gauge foreign body forceps is a safer, more effective, and convenient technique compared with the conventional approach.

Endotamponades in pars plana vitrectomy for metallic intraocular foreign body associated with endophthalmitis

AIM: To study the criterion-reference of endotamponades in pars plana vitrectomy for metallic intraocular foreign body (MIOFD) associated with endophthalmitis. METHODS:Thirty-six patients of MIOFD with endophthalmitis accorded with Exclusion and inclusion criteria were retrospectively analyzed. A detailed analysis of the patients' natural factors, preoperative examinations, intraoperative endotamponades choice, postoperative complications and therapeutic effects was performed. RESULTS: BSS was used in 4 eyes without obvious retinal damage. There was no postoperative complication and their visual acuity (VA) was improved. Sixteen eyes that had mild retinal damage filled with C3F8 gas. The postoperative VA improved in 10 eyes (62.5%), 4 eyes (25.0%) remained unchanged and 2 eyes (12.5%) decreased. Only 2 cases occurred postoperative retinal detachment in gas group. Another 16 eyes with serious retinal damage were treated with silicone oil. Postoperative VA of 9 eyes (56.3%) improved, 3 eyes (18.8%) remained unchanged and 4 eyes (25.0%) decreased. The silicone oil group had higher incidence of postoperative complications, but the incidence of secondary treatment had no significant different between silicone oil and gas group. CONCLUSION: An appropriate choice of endotamponades in vitrectomy surgery for MIOFB with endophthalmitis is important for prognosis.

A presumed iridocyclitis developed to panophthalmitis caused by a non-metallic intraocular foreign body

Dear Editor,I write to present one case report of a patient suffered the panophthalmitis caused by non-metallic foreign body with no etiologic agent and recovered quickly by phacoemulsification and vitrectomy with silicone oil tamponade.Ocular trauma remains a major cause of blindness, particularly in the working-age population.

Removal of Intralenticular Magnetic Foreign Bodies with Intraocular Magnet

Purpose: To investigate the possibility of conservation of the lens after removal of intralenticular magnetic foreign bodies with intraocular magnet.Methods: Intralenticular magnetic foreign bodies of 15 patients were removed by using an intraocular magnet. The lens of each injury eye was conserved. Follow-up observation of these cases ranged from one to four years.Results: The intralenticular magnetic foreign bodies of 15 patients were successfully removed.The lens of each injury eye was conserved and the transparence of the lens was properly maintained. Sizes of these foreign bodies were measured, ranging from 0.3 mm to 3mm in diameter. The follow-up observation showed that the corrected visual acuity of 14 cases was not changed after operation.Conclusions: The intraocular magnet is very helpful for removal of magnetic foreign bodies from the transparent lens. This magnet allows removing of the foreign body by the surgeon and no damage to the lens was induced during the operation. Thus, maintenance of visual acuity of most of the patients can be achieved.

General anesthesia with endotracheal intubation ensures the quick removal of magnetic foreign bodies:A case report

BACKGROUND The incidence of ingestion of magnetic foreign bodies in the gastrointestinal tract has been increasing year by year.Due to their strong magnetic attraction,if multiple gastrointestinal foreign bodies enter the small intestine,it can lead to serious complications such as intestinal perforation,necrosis,torsion,and bleeding.Severe cases require surgical intervention.CASE SUMMARY We report a 6-year-old child who accidentally swallowed multiple magnetic balls.Under timely and safe anesthesia,the magnetic balls were quickly removed through gastroscopy before entering the small intestine.CONCLUSION General anesthesia with endotracheal intubation can ensure full anesthesia under the condition of fasting for less than 6 h.In order to prevent magnetic foreign bodies from entering the small intestine,timely and effective measures must be taken to remove the foreign bodies.

A New Method of 3-Dimensional Localization of Intraocular Foreign Bodies Using CT Imaging:A Role of Optic Nerve

Computed tomography（CT） is considered the most sensitive method for the detection of intraocular foreign bodies（IOFBs）. The purpose of this study was to evaluate a new method of 3-dimentional（3D） localization of IOFBs that takes advantage of the anatomical structure of the optic nerve and to assess the clinical outcomes using this new method. Twenty-two trauma patients with IOFBs or suspected IOFBs admitted to our hospital were scanned with multislice CT（MSCT） between July and December 2003. All scanning was performed with a 16-row spiral CT in axial plane using a sequential scanning protocol. During the scanning, the eyeball of the patient was kept stable and was not allowed to rotate internally or externally. Section collimation was set at 16 mm × 0.75 mm. Table feed was 12 mm. Reconstruction index was 0.75 mm. After scanning, the reconstructed images were loaded into a workstation to create the multiplanar reconstruction images with the aid of the 3D software. We compared the localization results with the operative findings. Multiplanar reconstruction images showed IOFBs in all 22 patients. IOFBs occurred in the eyeball of 14 patients, in the wall of the eyeball of 5 patients and in the posterior orbits of 3 patients. Different surgical procedures were designed according to the localization by this new method and all IOFBs were successfully removed. All of these foreign bodies were metallic and the localization of IOFB using MSCT was consistent with that found by operative findings. It was suggested that MSCT is a simple and effective imaging modality for the localization of IOFBs. In our study, we localized the IOFBs more quickly and accurately by taking advantage of the fixed position of the intraocular segment of the optic nerve, and determined the necessary surgical parameters.

Delayed presentation of intracameral graphite foreign body in a child: school trauma

We report a case of large graphite foreign body(FB) in the anterior chamber of eye of a 4-yearold child,incurred during unsupervised play.Despite delayed presentation,the eye had few signs of resolved inflammation which allowed safe extraction of the FB bimanually through limbus.School play,especially in young children,should be under supervision and free of sharp objects.Graphite is inert while inside the eye,and even large pieces can be well tolerated for long time in absence of infection.

Clinical characteristics and prognostic factors for visual outcome in 669 patients with intraocular foreign bodies

AIM: To describe the clinical characteristics and analyze prognostic factors that influence visual outcome in 669 patients with intraocular foreign bodies(IOFBs).METHODS: Medical records of 669 patients with IOFBs from West China Hospital were reviewed. Best corrected visual acuity(BCVA) values were recorded using standard Snellen acuity chart and were converted to logarithm of the minimum angle of resolution(log MAR) scale for statistical analysis. The visual outcome was defined by the final BCVA(excellent visual outcome: final BCVA of 20/40 or better;poor visual outcome: final BCVA less than 20/200). Statistical analysis of collected data was performed using IBM SPSS Statistics version 23. A 2-tailed P value of less than 0.05 was considered statistically significant throughout the study. RESULTS: The average age ranged from 1 to 79 years old(mean age, 34.8±12.7 SD) and the majority of patients were men(626, 93.6%). The major cause of ocular injury was hammering(383, 57.2%). Almost all the patients(97.8%) underwent surgeries(97.8%) and the average time interval between injury and surgery was 26.4±322.3 d(0-7300), while 327 patients received surgeries within 24 h(48.9%) and 590 patients received surgeries within seven days(88.2%) after IOFBs injury. The poor BCVA was associated with older age(P=0.013), larger IOFBs size(P<0.001), presence of complications(P<0.001) and worse presenting BCVA(P<0.001). On the contrary, younger age(P=0.005), smaller IOFBs size(P<0.001), absence of complications(P<0.001) and better presenting BCVA(P<0.001) were considered to relate to excellent BCVA.CONCLUSION: Multiple prognostic factors may influence the final visual outcome, including age, size of IOFBs, complications and presenting BCVA. Meanwhile, further education and promotion on eye protection should be taken for the improvement on self-protection and selfhealth awareness.

Expansively Hemorrhagic Foreign Body Granuloma at the Pelvis Caused by Microscopic Materials

A foreign body granuloma is a mass lesion consisting of a foreign body with host reaction. Its diagnosis is not always easy in respect of its similarity to soft tissue sarcoma. The most common foreign body is surgical sponge which can be detectable macroscopically. We present a foreign body granuloma in the left buttock caused by microscopic surgical materials that developed into a large lesion. An 80-year-old man with a history of surgery for dislocation of the left hip 20 years earlier, presented with a slowly growing mass that had expanded rapidly over the preceding 2 months. Histological examination revealed organizing granulation tissue surrounding the scattered foreign materials. One should be aware of foreign body granuloma at previously operated sites even without a retained macroscopic gauze sponge.

A Novel Technique for Removal of Urogenital Magnetic Foreign Bodies

Background: There were 800 individual case reports of urogenital foreign bodies in the English literature from 1755 to 1999. The use of urogenital foreign bodies for sexual pleasure is a common occurrence in today’s population. The aim of this discussion is the management of scrotal injury caused by magnetic urogenital foreign bodies. Case Presentation: 56-year-old male with scrotal tissue entrapped between two opposed magnet rings. Self-reported attempts at removal were unsuccessful and caused for presentation to the emergency department. Additional attempts at removal by medical staff unsuccessful in emergency department and therefore the patient proceeded to the operating room. Intraoperatively the use of two cardiac magnets allowed for removal without a need for invasive surgical procedure. Conclusion: Cardiac magnets are preferred means of removal for entrapped skin between magnetic foreign bodies that could be utilized at the bedside.

Extraction of Posterior Polar Intraocular Foreign Bodies with Sodium Hyaluronate Backsiphon Technique

Purpose: To explore the new technique on the removal of posterior polar intraocular foreign bodies (IOFBs).Methods: Dint of viscoelasticity and cohesiveness of ophthalmic viscoelastics (sodium hyaluronate) was used to wrap, dissociate and suspend IOFBs. Then IOFBs were approached and backsiphoned by using self-made backsiphon syringe needles which were selected according to the size and shape of IOFBs. The IOFBs are removed with the inflow of sodium hyaluronate naturally surging into the needles.Results: Posterior polar IOFBs in 13 cases (13 eyes) were all removed successfully at one time. There were no accidental injuries or complications. The postoperative vision in 11 cases (11 eyes) was improved, unchanged in 1 case (1 eye) and decreased in 1 case ( 1 eye).Conclusions: The technique using viscoelastics to dissociate, suspend and backsiphon IOFBs during the removal of the posterior polar IOFBs can evidently decrease operative difficulty, injury and complications.

Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis

Objective To explore the feasibility and efficiency of a novel magnetic compression anastomats(MCAs) in intestinal anastomosis.Methods A total of 36 male mongrel canines underwent intestinal anastomosis using traditional hand-sewn(n=18) or a novel MCAs(n=18).We compared the anastomosis time,postoperative complications,bursting strength of anastomoses,gross appearance,and pathology between two groups at each time-point of follow-up.Results The mean anastomosis time with MCAs was significantly less than that with hand-sewn(8.50±1.95 vs.31.1±4.32 minutes,P<0.001).The blood stools and intussusceptions occurred in both groups during follow-up period.Only 1 mongrel canine receiving intestinal anastomosis by MCAs experienced anastomotic leakage.The average bursting pressure of anastomoses obtained from mongrel canines undergoing intestinal anastomosis by MCAs was significantly higher than that by traditional hand-sewn at 1 week's follow-up time(P<0.05).Gross appearance of the anastomoses constructed by MCAs was relatively smoother and flatter.Pathological evalution of anastomoses revealed that general inflammation was greater in hand-sewn anastomoses than magnetic anastomosis.Conclusion The magnetic compression anastomat is a safe and effective device of sutureless intestinal anastomosis in canine models.

Clinical features,radiological imaging,and treatment strategies of nonmetallic intraorbital foreign bodies:a retrospective analysis

AIM:To provide comprehensive data on nonmetallic intraorbital foreign bodies(IOFBs)by summarizing and analyzing material types,clinical manifestations,imaging features,and treatment strategies.METHODS:Totally 28 nonmetallic IOFB cases treated at Shengjing Hospital of China Medical University from 2012 to 2020 were retrospectively reviewed.The types of foreign bodies,clinical features,imaging manifestations,and treatment outcomes were analyzed.RESULTS:Among all cases,67.8%(19/28)of the foreign bodies were organic.The top three entrances were the upper eyelid skin(7/28),lower fornix conjunctiva(6/28),and lower eyelid skin(4/28).In most cases(11/28,39.3%),foreign bodies remained in the medial orbits.The major clinical manifestations included eyelid redness and swelling(20/28,71.4%),conjunctival congestion and edema(17/28,60.7%),and ophthalmoptosis(15/28,53.6%).Infection was the main complication,which occurred in 57.1%(16/28)of all cases.Computerized tomography(CT)values differed for different foreign bodies and varied in the different periods after injury.The plant-and grease-derived foreign bodies and the surrounding pus cysts showed different signals on magnetic resonance imaging(MRI).The prognosis varied with different foreign body types,surgery timing,and intraoperative management.CONCLUSION:The majority of nonmetallic IOFBs are organic and often remain in the superior,medial,and inferior areas of the orbit.Clinical manifestations vary owing to their different textures.CT and MRI facilitate the identification of foreign body materials.Plant-derived foreign bodies should be completely removed,and surgical treatment is a complicated process.

Clinical experience in the treatment of children who swallowed multiple magnetic foreign bodies: A report of five cases

Background:Several clinical reports have been published on complications resulting from swallowing multiple magnetic foreign bodies.This study aimed to summarize the clinical experience of managing children who swallowed multiple magnetic foreign bodies.Methods:We reviewed the clinical records of five children who swallowed multiple magnetic foreign bodies and were admitted to our hospital during June 2012 to June 2014.Details of the patients' presentation,imaging studies,complications and treatment were recorded.Results:All five children suffered from gastrointestinal perforation and intestinal obstruction.The magnetic foreign bodies caused local bowel wall tissue ischemia necrosis and perforation as well as other complications associated with fistula formation.The magnets were finally removed by laparotomy surgery.Conclusion:If magnetic foreign bodies cannot be removed by endoscopy,an operation is suggested as soon as possible to avoid serious complications.

Characteristic analysis on susceptibility weighted imaging of intravitreous foreign body Of autologous eyelashes in rabbits

Objective： To explore the characteristics of susceptibility weighted imaging （SWI） of the intravitreous foreign body of autologous eyelashes in rabbits. Methods： A total of 12 New Zealand white rabbits, either sex, weighing 2.5-3.5 kg, and provided by the Experimental Animal Center of Henan Province were employed in this study. For each rabbit, 5 autologous eyelashes （1 cm in length and 0.2-0.3 mm in diameter） were implanted into the right ocular vitreum, while the left control ocular vitreum received sham operation but nothing was implanted. SWI sequential test was made 2 hours postoperatively. Then the rabbits were killed and the specimens of the vitreous bodies of the rabbits were obtained. Hematoxylin and eosin staining and histological examinations were performed. Results： The autologous eyelashes in 8 ocular vitreums of rabbits showed linear low signal intensity on the magni-tude images and susceptibility weighted images, but linear high signal intensity on the phase images. Among the 12 experimental rabbits, 5 eyelashes in the right vitreum were completely shown in 3 rabbits, partly shown in 5 rabbits （2 eyelashes shown in 3 rabbits and 3 eyelashes shown in 2 rabbits）, and not shown in 4 rabbits. Conelusions： SWI of the foreign body ofintravitreous autologous eyelashes in rabbits has its own characteristics. The combined application of SWI sequential magnitude images, susceptibility weighted images and phase images is helpful to the detection and diagnosis of intravitreous autologous eyelashes in rabbits.

未发现眼内金属异物的外伤性白内障病例1例报告

外伤性白内障在临床中较常见,通常非金属异物进入眼内,患者无眼内反应,只表现为外伤性白内障,而金属异物进入眼内易引起并发症。异物进入眼内可通过眼科检查发现,或行白内障手术找到异物。然而,临床中极少部分患者会出现漏诊。本文报告1例眼内金属异物消失的外伤性白内障病例(有眼部外伤异物进入眼内病史以及体征,但术前、术中、术后均未发现异物),并分析金属异物消失的原因。

儿童消化道异物35例手术治疗分析

目的:回顾性分析需手术治疗的儿童消化道异物的临床资料,总结其临床诊治经验。方法:选取2016年1月—2021年12月深圳市儿童医院行手术治疗的35例消化道内异物患儿作为研究对象,分析不同类型异物的临床特点、诊治方法和预后情况。结果:所有病例中,男性28例(80%),女性7例(20%)。年龄范围从11月~9岁。临床症状主要为腹痛哭闹19例(54.29%)和呕吐17例(48.57%)。所有患者做X线检查,提示消化道异物阳性33例(94.29%),包括:多个磁珠30例,尖锐金属异物3例;提示消化道异物阴性2例(5.71%),包括泡发球1例、枣核1例。做超声检查共13例,提示消化道异物阳性10例(76.92%),其中有2例患儿在超声检查中提示消化道异物阳性,而在X线检查中则为阴性。全部患儿均接受手术治疗,术后随访3~6月,发生消化道梗阻并发症5例。结论:磁珠和尖锐金属异物是常见需手术治疗的儿童消化道内异物种类,腹痛哭闹和呕吐是该类疾病的主要症状,儿童消化道异物可引起较为严重的并发症,特别是多个磁珠更易引起的消化道并发症,家长及儿科医生需重点关注。

眼球穿通伤并球内异物手术疗效分析

目的探讨眼球穿通伤并球内异物手术治疗效果。方法对2019年1月至2019年9月共9例外伤导致的眼球穿通伤并球内异物的临床资料进行回顾性分析.根据伤口位置、异物性质及滞留部位等分组,根据具体情形选择不同手术方式,通过观察术前术后视力变化情况,评估不同外伤对视力影响情况。结果一期手术均顺利取出异物,二期手术3例行人工晶体悬吊术,1例行硅油取出+人工晶体悬吊术,术后随访3~5个月,随访期末最佳矫正视力手动者2例,0.05者1例,0.1~1.2者6例,相对于术前视力,及时手术的患者,视力明显提升。术前与术后视力比较P<0.05,差异有统计学意义。结论眼球损伤病情比较复杂,需要根据具体问题具体分析才能取得较好的临床效果,预后恢复情况与受伤程度相关。

全球劳动人口眼内异物伤流行趋势分析

目的:探讨1990—2019年全球劳动人口眼内异物伤患病情况及发展趋势。方法:使用2019年全球疾病负担研究(Global Burden of Disease 2019,GBD 2019)数据库。以眼内异物伤年龄标准化患病率为因变量,年份为自变量构建Joinpoint回归模型。采用Joinpoint 5.0.2软件进行模型构建和1990—2019年全球眼内异物伤年龄标准化患病率的平均年度变化百分比的计算,比较全球不同国家或地区劳动人口眼内异物伤年龄标准化患病率的变化趋势。结果:2019年,全球各区域劳动人口眼内异物伤年龄标准化患病率最高为中国(180.4/10万),最低为大洋洲(66.2/10万)。1990—2019年,全球各区域年龄标准化患病率流行趋势不一致,除西欧、中欧、东南亚等5个区域呈现小幅度上升外,其余大部分地区呈不同幅度的下降趋势,其中以中国和东亚的下降幅度最大,平均年度变化百分比分别为-1.43%(95%CI:-1.65%~-1.22%)和-1.42%(95%CI:-1.63%~-1.21%)。全球劳动人口眼内异物伤患病率最高的年龄组为45~49岁;在不同社会人口指数地区,患病率最高的年龄组普遍集中在40~44岁和45~49岁;在不同GBD区域,患病率最高的年龄组各有不同,中国主要集中在60~64岁。结论:1990—2019年全球劳动人口眼内异物伤年龄标准化患病率分布不均,整体呈下降趋势。