Trauma and Miscellaneous Disorders in Retina by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9789811385506
Publisher: Springer Singapore

Surgical Management: Posterior Segment IOFBs

The removal of posterior segment IOFBs should be conducted via pars plana vitrectomy (PPV) in most cases (Figs. 9.10, 9.11, 9.12 and 9.13 refer to a 56-year-old patient referred to a retinal specialist with retinal detachment and history of penetrating ocular trauma without IOFB found in initial ocular ultrasound. The first approach after trauma was to perform corneal suture associated with phacoemulsification and implantation of IOL. After that another ocular ultrasound was performed showing an IOFB and retinal detachment. Special thanks to Dr. Ricardo Luz Leitão Guerra, from Clínica de Olho Leitão Guerra, Salvador-BA, Brazil; Yeh et al. 2008) with advantages including direct visualization of IOFB for removal and ability to remove media opacities concomitantly, such as cataract and vitreous hemorrhage (Greven et al. 2000). Strategies for IOFB removal depend on size and composition. Small (<1.0 mm), metallic, ferromagnetic FBs may be removed with an intraocular magnet, while small nonferrous material can be removed with the vitreous cutter alone. Medium-sized IOFBs (1.0–3.0 mm) can be removed with basket forceps, while larger (3.0–5.0 mm) or glass FBs can be removed with the use of diamond-coated forceps. Small and some medium-sized FBs can be removed through the sclerotomy with enlargement of the wound, if needed, while FBs larger than 4.0 × 4.0 × 4.0 mm may require a scleral tunnel removal (Yeh et al. 2008). After extraction of the IOFB, a thorough retinal examination with scleral depression should be performed to check for retinal tears, retinal detachment, or choroidal detachment. Laser photocoagulation is used to treat retinal tears, and retinal cryopexy is performed if blood precludes good laser treatment. Gas or oil tamponade can be used for retinal detachment. An encircling scleral buckle may be placed depending on the anatomy or anticipated likelihood of PVR development (Loporchio et al. 2016).

Fig. 9.10PPV with retinal detachment and superior hemorrhage

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