Good visual rehabilitation in a patient without traumatic cataract surgery after removal of a ferrous intravitreal foreign body by external magnetic extraction through a pars plana incision: A case report

Background: There is an increasing trend toward performing plana vitrectomy and cataracts. Herein, we describe a case of good visual rehabilitation in a patient without traumatic cataract surgery after removal of a ferrous intravitreal foreign body (IVFB) using an external approach. Case presentation: A 44-year-old man presented to our ophthalmology department because of decreased visual acuity after a penetrating trauma to the left eye 2 days earlier. Best-corrected visual acuity (BCVA) was 20/200. An examination revealed a midperipheral self-sealing corneal penetrating wound at the 5 o’clock position, in addition to a mild inflammatory reaction in the anterior chamber. Pupil dilation revealed peripheral anterior and posterior capsular violations, with subcapsular opacity involving the visual axis. A small metallic-like foreign body suspended in the vitreous was confirmed by B-scan ultrasonography and orbital computed tomography. Retinal injury and vitreous hemorrhage were excluded by B-scan ultrasonography and binocular indirect ophthalmoscopy. This IVFB was successfully removed by external magnetic extraction through a pars plana incision. At the 2-week follow-up, the traumatic cataract was partially resolved, and BCVA improved to 20/125. At the 3-month follow-up, the traumatic cataract was mostly resolved, the visual axis was clear under a normal pupil, and BCVA improved to 20/20. Peripheral localized lens opacity was foun

Background Among patients with a posterior segment intraocular foreign body (IOFB) and a traumatic cataract, visual rehabilitation poses a unique challenge to ophthalmic surgeons. There is an increasing trend toward performing pars plana vitrectomy (PPV) and simultaneous cataract extraction in the management of these patients [1][2][3]. However, previous study reported spontaneous resolution of a traumatic cataract after removal of an intralenticular foreign body and lens preservation remaining localized opacity after IOFB removal by PPV [4][5]. The external approach to the removal of a metallic IOFB remains to be a viable treatment option in select cases [6]. Herein, we describe a case of traumatic cataract caused by a small ferrous intravitreal foreign body (IVFB), in which good visual rehabilitation was achieved without traumatic cataract surgery after removal of the IVFB through a pars plana incision using an external magnet.

Case Presentation
A 44-year-old healthy man was referred to our ophthalmology department because of decreased visual acuity in his left eye for 2 days. The patient had suffered a penetrating trauma to his left eye while hammering metal without safety glasses 2 days before. On presentation, the best corrected week, 1% pranoprofen eye drops 4 times a day for 4 weeks, and 0.5g levofloxacin tablet a day for 4 days. The patient was followed up 1 day, 3 days, 2 weeks, 3 months, 6 months, and 12 months after 4 the surgery. If necessary, traumatic cataract removal by phacoemulsification and intraocular lens implantation were planned.
At the follow-up of 2 weeks after the surgery, the BCVA had improved to 20/125, the traumatic cataract had partially resolved (Figs. 2 A, B), the range and density of the shadow reduced (Fig. 2C Lenticular injury as a result of an IOFB may occur if the foreign body passes through the lens [10].

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 [11].
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

Supplementary Files
This is a list of supplementary files associated with this preprint. Click to download. CAREchecklist.pdf