The prognosis of traumatic eye injuries associated with IOFBs varies greatly depending on a number of factors, which include the time between trauma and IOFB extraction, initial visual acuity, entrance wound location, nature of IOFB, location of IOFB, preoperative retinal detachment, presence of intraocular hemorrhage, presence of endophthalmitis, and primary surgical repair combined with IOFB removal and the occurrence of postoperative complications . PPV is the most common surgical approach for the removal of a posterior segment IOFB, as it provides direct viewing and controlled surgery [8-9]. The aim of the treatment is to restore ocular integrity and to obtain a good visual outcome. However, in selected patients with small ferrous foreign bodies positioned in the vitreous and no retinal injury, a good visual outcome can be achieved by removal of the IVFB by external magnetic extraction through a pars plana incision .
We described the case of a 44-years-old healthy man with a traumatic cataract involving the visual axis caused by a small metallic-like IVFB in his left eye. The IVFB was removed by external magnetic extraction through a pars plana incision. Spontaneous resolution of the traumatic cataract was observed. At the last follow-up 12 months after the removal of the IVFB, BCVA improved to 20/20, stable localized lens opaciy, not involving the visual axis, was found, and a fundus examination showed no obvious abnormality.
Lenticular injury as a result of an IOFB may occur if the foreign body passes through the lens . Removal of an IOFB in the presence of a traumatic cataract and associated retinal pathology is difficult. Under such circumstances, cataract extraction is often necessary to enable clear visualization of the posterior segment. Important advances in microsurgical and vitreoretinal instrumentation and techniques (e.g., wide angle viewing systems, high-speed cutters, and improved intraocular instrumentation) have improved the outcomes of these types of ocular injuries.
In cases of clear lens damage and extensive cortical material in the anterior chamber, which may cause increased IOP or a severe inflammatory reaction, lens removal is performed. However, a minor injury to the lens may result in localized nonprogressive lens opacity that does not require surgery. In these cases, epithelial cells may regenerate at the site of the injury and restore capsular continuity, thus limiting the free passage of ions and fluid that can result in progressive cataract formation .
In the present case, a small metallic-like IVFB was identified by B-scan ultrasonography and orbital computed tomography, and no signs of endophthalmitis, vitreous hemorrhage, or retinal injury were found. In such cases, removal of the IVFB using an external approach is an easy and a viable treatment option. To allow clear visualization of the posterior segment for the removal of this IVFB by PPV, extraction of the traumatic cataract, which interfered with the visual axis, was necessary. Removal of the posterior hyaloid, an important surgical goal, was difficult in this relatively young patient. There was also a potential drop of this IVFB on the macula.
In the absence of lens material in the anterior chamber in the presence of a traumatic cataract, some literature states that it is better to treat the eye with topical steroids to control inflammation firstly. In the present case, a slit lamp examination revealed a mild inflammatory reaction in the anterior chamber and no cortical material in the chamber. The patient’s IOP was normal. Small peripheral anterior and posterior capsular violations were observed. Although the traumatic cataract interfered with the visual axis, considering the size and location of the capsular violations and the mild nature of the inflammatory reaction, in addition to the potential possibility of restoration of capsular continuity and spontaneous resolution of the traumatic cataract, the patient was treated with topical antibiotic and steroids to control the inflammation after the removal of the IVFB, and lens extraction was deferred. During the first 3 months follow-up after removal of the IVFB by external approach, the traumatic cataract was mostly resolved. The visual axis was clear under normal pupil and BCVA improved to 20/20. After pupil dilation, temporal localized lens opacity was found. There were no postoperative complications, such as secondary glaucoma or retinal detachment. At the last follow-up of 12 months after the surgery, localized lens opacity remained stable and BCVA was 20/20. A fundus examination revealed no obvious abnormality.
To the best of our knowledge, this is the first case of good visual rehabilitation without cataract and vitrectomy surgery in a patient with a penetrating eye injury, accompanied by an IVFB and a traumatic cataract. This case emphasizes the need for clinical education in terms of the management of an IVFB. When determining the need for a surgical intervention or conservative management in such cases, patient-related factors, the size and location of the IOFB, the location and extent of lenticular involvement, and associated injuries should be considered to obtain a good visual outcome.