- Email: [email protected]
Late detection of an intraocular foreign body after IOL implantation: A case report
The contact lens may also be used for specular microscopy of the epithelium since the specular reflex is not blurred by the reflex of the tear film. The picture is similar to that of scanning microscopy at low magnification. U sing this lens to examine the epithelium will provide new methods of evaluating the quality of ophthalmic surgery. It will be useful in corneal transplant evaluation, in evaluation of corneal tolerance of contact lens wearers, and in a great variety of corneal diseases. In addition, by filling the precorneal chamber with various solutions we can study their effect on the epithelium. Investigations of reflex photography with standard slitlamp photography equipment are in progress.
Late detection of an intraocular foreign body after IOL implantation: A case report
J.
L. Menezo, M. D. E. Ferrer, M. D. Valencia, Spain
ABSTRACT Report of an intraocular foreign body that was well-tolerated for over two years.
Key Words: B-scan ultrasonography, capsulotomy, intraocular lens (IOL), secondary implantation, synechia
A 30-year-old male from the Canary Islands was sent to our department for intraocular lens (IOL) implantation assessment. Two and a half years before, he had sustained an injury to his eye from the blast of a large drill explosion. According to the case history we received, the lesion consisted of a 3-mm corneoscleral perforation, with hyphema, and a cataract at the 5-0'clock position. The ophthalmologist who initially treated the patient noted that lens opacity made it impossible to examine the ocular fundus. He also suspected that there was vitreous opacification because of hemorrhage. After performing all routine ophthalmological examinations, we considered the patient an acceptable candidate for secondary implantation. The only sign of potential complications was an abnormal preretinal wave on the B-scan (Figure 1). This, however, was attributed to fibrin residues. Slitlamp examination revealed rupture of the sphincter, anterior synechias at the 3-0' clock position, a membranous cataract partially reabsorbed with numerous Elschnig's pearls, and extensive posterior synechias. Reprint requests to J. L. Menezo, M.D., Department o/Ophthalmology, Ciudad Sanitaria de la Seguridad Social "La Fe", Avenida Campanar 21, Valencia 9, Spain. AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
471
Fig. 3. Fig. 1.
(Menezo) B-scan ultrasonography performed after trauma but before cataract extraction.
(Menezo) Foreign body with the pupil contracted.
The pupil was immediately contracted to avoid displacement of the foreign body toward the vitreous and the stone was extracted through an inverse Charleuxtype 3lh-mm corneal incision under sodium hyaluronate (Healon ®) (Figures 4, 5, and 6).
The cataract was extracted by performing a wide anterior capsulotomy, freeing the synechias, and removing the cortical remnants and Elschnig's pearls by aspiration. On finding the posterior capsule thickened and partially opaque, we performed a wide capsulectomy with a Peyman wide-angle cutter vitrophage, simultaneously eliminating the anterior vitreous. The corneoscleral incision was lengthened to 6 mm , and following the introduction of a Sheets glide, a semiflexible Leiske anterior chamber lens was successfully implanted. Three days postoperatively, a black-gray, 3-mm foreign body appeared between the sphincter and optic zone of the lens. It seemed to be a stone of volcanic origin (Figures 2 and 3).
Fig. 2. 472
(Menezo) Foreign body with the pupil dilated.
Fig. 4.
(Menezo) Extraction of the foreign body under Healon ® with the Strampelli-Von Mandach forceps.
Fig. 5.
(Menezo) Foreign body removal through inverted corneal incision (Charleux type).
AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
Posteriorly dislocated anterior chamber intraocular lens Randolph L. Johnston, M.D. Philadelphia, Pennsylvania Randall J. Olson, M.D. Mano Swartz, M.D. L. Keith Gates, M.D. Salt Lake City, Utah ABSTRACT A case of a posteriorly dislocated anterior chamber intraocular lens (IOL) is reported. Fig. 6.
(Menezo) Postoperative appearance of the eye.
The patient was discharged with an uncorrected visual acuity of 20/30. The unusual feature of this case is that a foreign body of volcanic nature (lava) had been well tolerated inside the vitreous chamber for over two years and had not been detected by B-scan ultrasonography. Because of an anterior vitrectomy, it had been displaced toward the anterior chamber, wedging itself between the iris and the lens.
Key Words: anterior chamber intraocular lens, Choyce Mark VIII style lens, posterior dislocation
Complications of anterior chamber intraocular lenses include Ellingson's syndrome (uveitis-glaucoma-hyphema)l and corneal \ edema related to endothelial cell loss. Dislocation of anterior chamber intraocular lenses is much less frequent than dislocation of iris fixated lenses. 2 We present an unusual case of a posteriorly dislocated anterior chamber intraocular lens in the presence of an intact iris. CASE REPORT A 79-year-old female had a cataract extraction of the left eye under general anesthesia in October 1981. No details of the surgery are known, but the patient related that she experienced nausea: and vomiting for one week postoperatively and never regained good vision after surgery. She was told soon after surgery that the intraocular lens (IOL) had "slipped." In October 1982, she was referred to the University of Utah Medical Center. Best corrected visual acuity at this time was 20/20 in the right eye and 20/300 in the left eye with an aphakic correction. Applanation tonometry revealed an intraocular pressure of 16 mm Hg in the right eye and 20 mm Hg in the left eye. Slitlamp examination in the right eye disclosed mild nuclear sclerosis; in the left eye, superior stromal edema and 2+ endothelial pigment were seen. The anterior From the Scheie Eye Institute, Philadelphia, Pennsylvania, and the Department of Ophthalmology, University of Utah Medical Center, Salt Lake City, Utah. Reprint requests to Randall J. Olson, M.D., Department of Ophthalmology, University of Utah Medical Center, 50 North Medical Drive, Salt Lake City, Utah 84132.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
473
Late detection of an intraocular foreign body after IOL implantation: A case report
J.
L. Menezo, M. D. E. Ferrer, M. D. Valencia, Spain
ABSTRACT Report of an intraocular foreign body that was well-tolerated for over two years.
Key Words: B-scan ultrasonography, capsulotomy, intraocular lens (IOL), secondary implantation, synechia
A 30-year-old male from the Canary Islands was sent to our department for intraocular lens (IOL) implantation assessment. Two and a half years before, he had sustained an injury to his eye from the blast of a large drill explosion. According to the case history we received, the lesion consisted of a 3-mm corneoscleral perforation, with hyphema, and a cataract at the 5-0'clock position. The ophthalmologist who initially treated the patient noted that lens opacity made it impossible to examine the ocular fundus. He also suspected that there was vitreous opacification because of hemorrhage. After performing all routine ophthalmological examinations, we considered the patient an acceptable candidate for secondary implantation. The only sign of potential complications was an abnormal preretinal wave on the B-scan (Figure 1). This, however, was attributed to fibrin residues. Slitlamp examination revealed rupture of the sphincter, anterior synechias at the 3-0' clock position, a membranous cataract partially reabsorbed with numerous Elschnig's pearls, and extensive posterior synechias. Reprint requests to J. L. Menezo, M.D., Department o/Ophthalmology, Ciudad Sanitaria de la Seguridad Social "La Fe", Avenida Campanar 21, Valencia 9, Spain. AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
471
Fig. 3. Fig. 1.
(Menezo) B-scan ultrasonography performed after trauma but before cataract extraction.
(Menezo) Foreign body with the pupil contracted.
The pupil was immediately contracted to avoid displacement of the foreign body toward the vitreous and the stone was extracted through an inverse Charleuxtype 3lh-mm corneal incision under sodium hyaluronate (Healon ®) (Figures 4, 5, and 6).
The cataract was extracted by performing a wide anterior capsulotomy, freeing the synechias, and removing the cortical remnants and Elschnig's pearls by aspiration. On finding the posterior capsule thickened and partially opaque, we performed a wide capsulectomy with a Peyman wide-angle cutter vitrophage, simultaneously eliminating the anterior vitreous. The corneoscleral incision was lengthened to 6 mm , and following the introduction of a Sheets glide, a semiflexible Leiske anterior chamber lens was successfully implanted. Three days postoperatively, a black-gray, 3-mm foreign body appeared between the sphincter and optic zone of the lens. It seemed to be a stone of volcanic origin (Figures 2 and 3).
Fig. 2. 472
(Menezo) Foreign body with the pupil dilated.
Fig. 4.
(Menezo) Extraction of the foreign body under Healon ® with the Strampelli-Von Mandach forceps.
Fig. 5.
(Menezo) Foreign body removal through inverted corneal incision (Charleux type).
AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
Posteriorly dislocated anterior chamber intraocular lens Randolph L. Johnston, M.D. Philadelphia, Pennsylvania Randall J. Olson, M.D. Mano Swartz, M.D. L. Keith Gates, M.D. Salt Lake City, Utah ABSTRACT A case of a posteriorly dislocated anterior chamber intraocular lens (IOL) is reported. Fig. 6.
(Menezo) Postoperative appearance of the eye.
The patient was discharged with an uncorrected visual acuity of 20/30. The unusual feature of this case is that a foreign body of volcanic nature (lava) had been well tolerated inside the vitreous chamber for over two years and had not been detected by B-scan ultrasonography. Because of an anterior vitrectomy, it had been displaced toward the anterior chamber, wedging itself between the iris and the lens.
Key Words: anterior chamber intraocular lens, Choyce Mark VIII style lens, posterior dislocation
Complications of anterior chamber intraocular lenses include Ellingson's syndrome (uveitis-glaucoma-hyphema)l and corneal \ edema related to endothelial cell loss. Dislocation of anterior chamber intraocular lenses is much less frequent than dislocation of iris fixated lenses. 2 We present an unusual case of a posteriorly dislocated anterior chamber intraocular lens in the presence of an intact iris. CASE REPORT A 79-year-old female had a cataract extraction of the left eye under general anesthesia in October 1981. No details of the surgery are known, but the patient related that she experienced nausea: and vomiting for one week postoperatively and never regained good vision after surgery. She was told soon after surgery that the intraocular lens (IOL) had "slipped." In October 1982, she was referred to the University of Utah Medical Center. Best corrected visual acuity at this time was 20/20 in the right eye and 20/300 in the left eye with an aphakic correction. Applanation tonometry revealed an intraocular pressure of 16 mm Hg in the right eye and 20 mm Hg in the left eye. Slitlamp examination in the right eye disclosed mild nuclear sclerosis; in the left eye, superior stromal edema and 2+ endothelial pigment were seen. The anterior From the Scheie Eye Institute, Philadelphia, Pennsylvania, and the Department of Ophthalmology, University of Utah Medical Center, Salt Lake City, Utah. Reprint requests to Randall J. Olson, M.D., Department of Ophthalmology, University of Utah Medical Center, 50 North Medical Drive, Salt Lake City, Utah 84132.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 9, FALL 1983
473