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INTRAOCULAR FOREIGN BODIES

INTRAOCULAR FOREIGN BODIES. Risk factors of visual loss: 1) M echanism of injury 2)Size of the IOFB 3) Location of the IOFB 4)Endophthalmitis 5) PVR. 25% of patients who sustained IOFB injury had final visual acuities of less than 20/200.

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INTRAOCULAR FOREIGN BODIES

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  1. INTRAOCULAR FOREIGN BODIES

  2. Risk factors of visual loss: 1)Mechanism of injury 2)Size of the IOFB 3) Location of the IOFB 4)Endophthalmitis 5) PVR

  3. 25% of patients who sustained IOFB injury had final visual acuities of less than 20/200

  4. PREOPERATIVE PREPARATION History Ophthalmic examination Appropriate neuroimaging Consideration of antimicrobials

  5. HISTORY: Accurate history-taking with attention to the mechanism of injury (e.g. knife wound, explosive device, shotgun blast)

  6. OPHTHALMIC EXAMINATION: Visual Acuity Endophthalmitis Globerupture Retinal detachment An afferent pupillary defect

  7. NEUROIMAGING: CT SCAN B-scan ultrasonography Ultrasound biomicroscopy (UBM) X Ray MRI

  8. PREOPERATIVE SYSTEMIC ANTIBIOTICS: Gram-positive organisms - coagulase-negative staphylococci - streptococci Gram-negative Fungal organisms

  9. Third-generation fluoroquinolone: - levofloxacin Fourth-generation fluoroquinolone: - moxifloxacin

  10. OPERATIVE CONSIDERATIONS Timing of surgery (delayed versus immediate) The route and instruments used for IOFB extraction The role of intraoperative antibiotics

  11. Delayed versus immediate intraocular foreign body removal The presence or absence of clinical endophthalmitis The stability of the patient for an extended surgical procedure The availability of well trained operating room personnel

  12. Advantages to immediate IOFB removal: 1) A decrease in the risk of endophthalmitis 2) A decrease in the rate of PVR 3) A single procedure under anesthesia with its attendant risks

  13. Advantages to delayed IOFB removal: 1) Better integrity of the repaired laceration 2)Less severe anterior segment pathology (e.G. Resolution of corneal edema, hyphema resorption) 3)The presence of a PVD 4)Resorption of some V.H

  14. ROUTE OF IOFB EXTRACTION Strategies for IOFB extraction at this point depend on the nature of the material and its size

  15. intraocular magnet: Small (<1.0 mm) metallic ferromagnetic IOFBs

  16. basket forceps: Medium-sized IOFBs (1.0–3.0 mm) Metallic Stone concrete

  17. diamond-coated forceps: Larger IOFBs (3.0–5.0 mm) Glass fragments

  18. POSTOPERATIVE CARE: endophthalmitis (5-7%) RD (6.3 to 36.8%) PVR ( 6.7 to 46% )

  19. Inert foreign body: - Stone - Glass - Porcelain - Plastic - cilia

  20. Reactive foreign body: - Zinc - Aluminum - Copper - iron

  21. Zinc and aluminum: - Minimal inflammation - Encapsulated

  22. SIDEROSIS Risk factors: - Content - Location

  23. RPE cells Pars plana TM Corneal epithelium Lens epithelium Pupillary constrictor muscle

  24. CLINICAL SIGNS: Nyctalopia ↓ VL Mydriasis Iris heterochromia Brown deposit beneath the ant. Lens capsule cataract

  25. Peripheral retinal pigmentation diffuse retinal pigmentation Optic disc atrophy POAG

  26. Abnormal ERG Increased a-Wave and normal b-Wave Diminishing b-Wave

  27. CHALCOSIS

  28. IOFBs containing over 95% copper : severe , rapidly progressive purulent endoph-thamitis

  29. IOFBs containing between 85 and 95% copper: visual loss→ deposition of copper in 1) descment΄s membrane 2) ant. Lens capsule 3) vit. Cavity 4)ILM

  30. K-F ring Ant. Subcapsular sunflower cataract Greenish discoloration of the vitreous Greenish refractile deposits in the ILM

  31. IOFBs containing less than 85 % copper usually produce no detectable change

  32. CONCLUSIONS: IOFBs are common in open globe injuries Clinicians must remain suspicious of a possible IOFB in any traumatized eye

  33. پایان

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