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Removal of an Intraocular Copper Foreign Body
128
NOTES, CASES, INSTRUMENTS
2, the first operation of retroplacement of the medial rectus and resection of the lateral rectus, was completely reversed by resection of the medial rectus and retroplacement of the lateral rectus at the second operation. I n spite of this, approximate orthophoria was obtained (fig. 6 ) . Overcorrections after squint surgery should not, therefore, be feared. Both resec tion and retroplacement are reversible opera tions. SUMMARY
T w o patients are reported who, after recession-resection operations for conver gent strabismus, remained with a divergent strabismus and abolition of adduction in the operated eye. T h e false paralysis of the medial rectus was due to resistance of the resected lateral rectus, as shown by the forced duction test, with forceps, under general anesthesia. T h e postoperative divergent strabismus and limitation of adduction were corrected by retroplacing the lateral rectus which had previously been resected. Marcel Duhaut 2959.
REMOVAL O F AN INTRAOCULAR COPPER FOREIGN BODY W I T H COMPLETE RECOVERY OF VISION HOWARD REED, M.B.,
M.S.
Winnipeg, Manitoba ROPER O.
MCDIARMID,
M.D.
Brandon, Manitoba AND
TIMOTHY DALY, M.B., D.O.M.S. Edmonton, Alberta
Most copper intraocular foreign bodies result in loss of the eye. Copper is nonmag netic so that a magnet is of no avail. Extrac tion is often impossible or may involve a difficult forceps removal which is very dam aging to the eye. If the foreign body contains a high percentage of copper and it is not re
moved, the eye usually degenerates rapidly into a state of phthisis bulbi. If the propor tion of copper is low chalcosis commonly occurs.* When the patient herein reported was first seen, the vision was reduced to hand movements by exudates in the vitreous. These were so dense and the inflammatory reaction so severe that the parents were warned it might become necessary to remove the eye. Fortunately, removal of the copper wire was followed by complete absorption of the exudates and restoration of normal vi sion. This complete disappearance of exten sive inflammatory exudation within the eye without disorganization of the vitreous seems to justify this record. CASE REPORT
A boy, aged 12 years, was cracking several feet of flexible rubber insulated wire like a stock whip when its frayed end struck his eye. The eye became inflamed and painful. Four weeks passed before it was realized that he had an intraocular foreign body and he was referred for treatment. When he was first seen, there was much photophobia and the eye was red and pain ful. Vision was reduced to hand movements. The pupil had already been dilated with atropine. There were no keratic precipitates. The lens was not damaged and no signs of chalcosis could be seen. At the 11-o'clock position, projecting into the vitreous was a conelike mass of solid yellowish-white exudate. The vitreous was hazy and in the re gion of the 6-o'clock position the exudate was thickened into two dense yellowishwhite masses resembling stalactites. The fundus could not be seen. The sense of light projection was accurate. This appearance seemed to suggest the presence of an intraocular foreign body at the 11-o'clock position and possibly another at the 6-o'clock position. Radiologie examina tion by Sweet's method revealed a piece of * Duke-Elder, W. S. : Textbook of Ophthal mology. St. Louis, Mosby, 19S4, v. 6, p. 6168.
NOTES, CASES, INSTRUMENTS wire in the region of the ciliary body at the 11-o'clock position. The next morning under general anes thesia, a conjunctival incision was made and the sclera exposed. The end of the wire was then seen projecting one mm. above the surface of the sclera. This was seized with forceps and the piece of wire eight mm. in length was withdrawn from the ciliary body. The conjunctiva was closed and one million units of crystalline penicillin were injected under the conjunctiva. Atropine was instilled each day and the patient made steady prog ress. He was discharged from the hospital six days later and instructed to continue to in still atropine drops into the eye three times daily. At this time there was no apparent change in the state of the vitreous although the eye was less inflamed. Ten days after the operation considerable absorption of the exudate had occurred and vision had im proved to 20/60. Five weeks after the operation his vision
129
had improved to 20/40. The masses of exu date had absorbed completely but there was still a haze in the lower part of the vitreous. He was seen the last time four months after operation when the eye appeared perfectly normal. No traces of exudate could be seen with the ophthalmoscope, nor could any cells be seen in the anterior vitreous with the slitlamp. His vision had returned to 20/20. One year later his parents wrote that the vision of the eye and its appearance were normal. Dr. G. E. Delory of the Department of Biochemistry of the University of Manitoba kindly analyzed the piece of wire and re ported : "The sample weighed 2.2 mg. Analysis for copper by the sodium diethyldithiocarbamate method showed a copper content of 85 percent. Qualitative tests for iron, zinc, phosphorus, tin, nickel, and manganese were negative. The small amount of material available prevented further analysis." Winnipeg Clinic.
OPHTHALMIC MINIATURE
. . . and so abroad by water to Eagle Court in the Strand, and there to an alehouse met Mr. Pierce, the Surgeon, and Dr. Clerke, Waldron, Turberville, my physician for the eyes, and Lowre to dissect several eyes of sheep and oxen, with great pleasure, and to my great information. But strange that this Turberville should be so great a man, and yet, to this day, had seen no eyes dissected, or but once, but desired that Dr. Lowre to give him the opportunity to see him dissect some. Pepy's Diary, July 3, 1668.
NOTES, CASES, INSTRUMENTS
2, the first operation of retroplacement of the medial rectus and resection of the lateral rectus, was completely reversed by resection of the medial rectus and retroplacement of the lateral rectus at the second operation. I n spite of this, approximate orthophoria was obtained (fig. 6 ) . Overcorrections after squint surgery should not, therefore, be feared. Both resec tion and retroplacement are reversible opera tions. SUMMARY
T w o patients are reported who, after recession-resection operations for conver gent strabismus, remained with a divergent strabismus and abolition of adduction in the operated eye. T h e false paralysis of the medial rectus was due to resistance of the resected lateral rectus, as shown by the forced duction test, with forceps, under general anesthesia. T h e postoperative divergent strabismus and limitation of adduction were corrected by retroplacing the lateral rectus which had previously been resected. Marcel Duhaut 2959.
REMOVAL O F AN INTRAOCULAR COPPER FOREIGN BODY W I T H COMPLETE RECOVERY OF VISION HOWARD REED, M.B.,
M.S.
Winnipeg, Manitoba ROPER O.
MCDIARMID,
M.D.
Brandon, Manitoba AND
TIMOTHY DALY, M.B., D.O.M.S. Edmonton, Alberta
Most copper intraocular foreign bodies result in loss of the eye. Copper is nonmag netic so that a magnet is of no avail. Extrac tion is often impossible or may involve a difficult forceps removal which is very dam aging to the eye. If the foreign body contains a high percentage of copper and it is not re
moved, the eye usually degenerates rapidly into a state of phthisis bulbi. If the propor tion of copper is low chalcosis commonly occurs.* When the patient herein reported was first seen, the vision was reduced to hand movements by exudates in the vitreous. These were so dense and the inflammatory reaction so severe that the parents were warned it might become necessary to remove the eye. Fortunately, removal of the copper wire was followed by complete absorption of the exudates and restoration of normal vi sion. This complete disappearance of exten sive inflammatory exudation within the eye without disorganization of the vitreous seems to justify this record. CASE REPORT
A boy, aged 12 years, was cracking several feet of flexible rubber insulated wire like a stock whip when its frayed end struck his eye. The eye became inflamed and painful. Four weeks passed before it was realized that he had an intraocular foreign body and he was referred for treatment. When he was first seen, there was much photophobia and the eye was red and pain ful. Vision was reduced to hand movements. The pupil had already been dilated with atropine. There were no keratic precipitates. The lens was not damaged and no signs of chalcosis could be seen. At the 11-o'clock position, projecting into the vitreous was a conelike mass of solid yellowish-white exudate. The vitreous was hazy and in the re gion of the 6-o'clock position the exudate was thickened into two dense yellowishwhite masses resembling stalactites. The fundus could not be seen. The sense of light projection was accurate. This appearance seemed to suggest the presence of an intraocular foreign body at the 11-o'clock position and possibly another at the 6-o'clock position. Radiologie examina tion by Sweet's method revealed a piece of * Duke-Elder, W. S. : Textbook of Ophthal mology. St. Louis, Mosby, 19S4, v. 6, p. 6168.
NOTES, CASES, INSTRUMENTS wire in the region of the ciliary body at the 11-o'clock position. The next morning under general anes thesia, a conjunctival incision was made and the sclera exposed. The end of the wire was then seen projecting one mm. above the surface of the sclera. This was seized with forceps and the piece of wire eight mm. in length was withdrawn from the ciliary body. The conjunctiva was closed and one million units of crystalline penicillin were injected under the conjunctiva. Atropine was instilled each day and the patient made steady prog ress. He was discharged from the hospital six days later and instructed to continue to in still atropine drops into the eye three times daily. At this time there was no apparent change in the state of the vitreous although the eye was less inflamed. Ten days after the operation considerable absorption of the exudate had occurred and vision had im proved to 20/60. Five weeks after the operation his vision
129
had improved to 20/40. The masses of exu date had absorbed completely but there was still a haze in the lower part of the vitreous. He was seen the last time four months after operation when the eye appeared perfectly normal. No traces of exudate could be seen with the ophthalmoscope, nor could any cells be seen in the anterior vitreous with the slitlamp. His vision had returned to 20/20. One year later his parents wrote that the vision of the eye and its appearance were normal. Dr. G. E. Delory of the Department of Biochemistry of the University of Manitoba kindly analyzed the piece of wire and re ported : "The sample weighed 2.2 mg. Analysis for copper by the sodium diethyldithiocarbamate method showed a copper content of 85 percent. Qualitative tests for iron, zinc, phosphorus, tin, nickel, and manganese were negative. The small amount of material available prevented further analysis." Winnipeg Clinic.
OPHTHALMIC MINIATURE
. . . and so abroad by water to Eagle Court in the Strand, and there to an alehouse met Mr. Pierce, the Surgeon, and Dr. Clerke, Waldron, Turberville, my physician for the eyes, and Lowre to dissect several eyes of sheep and oxen, with great pleasure, and to my great information. But strange that this Turberville should be so great a man, and yet, to this day, had seen no eyes dissected, or but once, but desired that Dr. Lowre to give him the opportunity to see him dissect some. Pepy's Diary, July 3, 1668.