Intralenticular Metallic Foreign Body*

NOTES, CASES, INSTRUMENTS

624

INTRALENTICULAR M E T A L L I C F O R E I G N BODY* A

CASE REPORT

D H A N W A N T S I N G H , F.R.C.S. Punjab, India R e t e n t i o n of a f o r e i g n b o d y in t h e eye is r a r e . T h e p r o p o r t i o n of i n t r a o c u l a r

foreign

b o d i e s i n all a c c i d e n t c a s e s is 1 : 3 0 0

(Crid-

l a n d , 1 9 3 3 ) . O f all c a s e s of i n t r a o c u l a r

for­

e i g n b o d i e s , o n l y five p e r c e n t a r e l o d g e d in t h e l e n s , t h e m a j o r i t y of c a s e s ( 7 5 p e r c e n t ) affecting t h e v i t r e o u s . O f 5 7 c a s e s of i n t r a ­ o c u l a r f o r e i g n b o d i e s t r e a t e d in t h i s h o s p i ­ tal d u r i n g t h e last five y e a r s

(1957-1961),

o n l y t h e p r e s e n t case i n v o l v e d a n i n t r a l e n t i c u l a r f o r e i g n b o d y ( 1 . 7 5 p e r c e n t of t h e t o t a l ) . In

the

passed

present

through

case,

l o d g e d in t h e lens n e a r tex,

resulting

the

the cornea in

an

foreign and

body

pupil

and

the posterior

cor­

intumescent

cataract.

F o r e i g n b o d i e s c o u l d be d i m l y s e e n in t h e d e e p e r p a r t of t h e lens w i t h a s l i t l a m p m i ­ c r o s c o p e . T h e case s h o w e d n o e v i d e n c e of s i d e r o s i s in a n y p a r t of t h e eye. CASE

REPORT

Mr. G. Singh, aged 30 years, while trying to hammer an iron nail into a wall, was injured (July 20, 1961) when a piece of iron flew into his right eye. Local treatment relieved the symptoms of pain and irritation but diminution of vision gradually took place. When he was examined about three and one-half months after the injury, there was a semilunar scar of 1.0 by 0.5 mm. involving the whole thickness of the cornea and situated at the level of the temporal edge of the pupil. The lens, under slitlamp microscopy, showed an intumescent cataract (fig. 1). Through the intumescent lens, on bright illumination, a semilunar foreign body of dark metallic color, 0.S to 1.0 mm. in size could be dimly seen through the dilated pupil in the deeper layers of the cortex in the lower one third of the lens near the 6-o'clock position. The anterior cap­ sule of the lens had an oval scar near the middle, and from it the thicker lens opacity fanned toward the posterior part of the lens and toward the foreign body. Slitlamp examination revealed no evidence of siderosis. There were no cells, flare or keratic precipitates. Tension was normal. On oph* From the Department of Ophthalmology, Gov­ ernment Medical College, Pattala.

Fig. 1 ( S i n g h ) . Intumescent cataract resulting from an intralenticular foreign body thalmoscopic examination, there was no red reflex. Posteroanterior and lateral X-ray views of the orbit confirmed the presence of a foreign body. The X-ray films showed only one foreign body so localization of the foreign body with contact lens radiopaque markings was not persued. Urine and routine blood examinations were normal. Operation. On November 11, 1961, the foreign body was removed by magnet. As the foreign body was situated in the deeper layers of the cortex, intracapsular removal of the lens at the same time was not planned because of the risk of the foreign body falling into the vitreous. The foreign body was removed by the tip of an electric magnet ap­ plied through the anterior chamber to the anterior capsule of the lens at the level of the foreign body after rupturing the capsule with a cystotome. After removal of the foreign body, the lens was removed by the extracapsular technique and the remains of the capsule were pulled out by forceps. The limbal section was closed by five corneoscleral preplaced 6-0 silk sutures. Postoperative recovery was uneventful and the patient was discharged on the seventh day. Upon examination, 15 days after the operation, the pa­ tient showed a quiet eye with no cells or flare. The cornea was clear. The pupil was round and central (fig. 2 ) . The fundus was normal. Vision improved

Fig. 2 ( S i n g h ) . The eye 15 days aftei OUU.UK'II

NOTES, CASES, INSTRUMENTS to 6/6, J. 1, with glasses. As the patient did not tolerate glasses due to diplopia, he was given a corneal contact lens for the operated eye. He has tolerated it well and has developed binocular vision. DISCUSSION

T h e case presents interesting characteris­ tics apart from being a relatively rare con­ dition. Although the foreign body was re­ tained for over three and one-half months, there was no siderosis of the lens. Usually siderosis is visible in three weeks (Sattler, 1899) but it may be delayed for years. Be­ fore the operation, the eye was absolutely

625

quiet with no evidence of inflammation. T h e patient had no complaint except diminution of vision. T h e opacification of the lens was progressive, although cases are described in which, curiously, although foreign bodies are lodged in a sector of the lens, the lens remains transparent (Pandit, 1958). I n other cases the lens may be completely ab­ sorbed, leaving the foreign body behind. Government Medical College. ACKNOWLEDGMENT

I am grateful to Prof. Prem Chandra for guid­ ance and help.

REFERENCES

Cridland: Tr. Ophth. Soc. U. Kingdom, 53:438, 1933. Duke-Elder, W. S.: Textbook of Ophthalmology. London, Kimpton, 1954, v. 6, pp. 6202, 6161. Pandit, Y. K. C : J. All-India Ophth. Soc, 5:93-101, 1958. Sattler: Internat. Cong. Ophth. Utrecht, 1899, p. 433. KAPOSI'S

SARCOMA*

W I T H OCULAR M A N I F E S T A T I O N S C H A R L E S M.

ALEXANDER,

M.D.

Washington, D.C. Kaposi's idiopathic multiple hemorrhagic sarcoma is a neoplastic disease characterized by soft, bluish-red skin nodules most com­ monly affecting the hands or the lower ex­ tremities. Lesions may occur occasionally on other parts of the skin surface. Although the predominant lesion is in the skin, vis­ ceral lesions occur with or follow the onset of the skin lesions in about 10 percent of the cases. On rare occasions they precede the skin nodules. There has been discussion as to whether the disease is found most fre­ quently in the Jewish or Italian ethnic groups. 1 It is agreed, however, that this dis­ ease is more common in males and that the highest incidence is in the age range of 40 to 70 years, although it may be found in children and adolescents. Its appearance in more than one member of a single family is uncommon. 2 This report describes a case of Kaposi's * From the Department of Washington Hospital Center.

Ophthalmology,

sarcoma on the eyelids of an American Negro following the onset of lesions typi­ cally situated in the lower extremities. I n the recent literature, Applemans, 3 et al., Lerman and Pinsky, 4 and McLaren 5 have reported Kaposi lesions on the eyelids. Sachs 6 has described a similar lesion on the conjunctiva of the lower fornix and Reese 7 has reported the lesion in the lacrimai sac. Graham 8 (1942) was one of the first to describe the ocular lesions of Kaposi's sar­ coma. Duke-Elder 9 also cites several cases of ocular Kaposi's disease. C A S E REPORT

J. M. (WHC 042437), an 84-year-old Negro presented at the Eye Clinic of the Washington Hospital Center on March 24, 1960, with the chief complaints of failing vision in the right eye and a painless swelling on the left lower lid for one month and unresponsive to hot compresses. Past history. He was first seen in 1937, at the age of 61 years, for a traumatic dislocation of the lens and a complicating glaucoma in the left eye. The lens was spooned out. The eye subsequently developed a total retinal detachment with no light perception; corneal opacification and phthisis bulbi ensued. He was next seen in 1941 with a mature senile cataract in the right eye. The cataract was removed uneventfully and vision was corrected to 20/20 with a +7.0D. sph. Z +7.5Ώ. cyl. ax. 170°. Between 19S4 and 1960 the intraocular pressure in the right eye became elevated and the vision de-