A case of treatment‑resistant uveitis with intraocular foreign body Dear Editor, Foreign objects can cause ocular damage in two major ways. First, they cause penetrating injuries and related complications, and the other caused by a foreign body infection, toxicity, and damage is caused by an inflammatory reaction. [1,2] The purpose of presenting this case is to draw attention to intraocular foreign body research at patients showing no evidence of trauma disrupts the integrity of the globe, the lens subcapsular epithelial pigmentation levels in patients not responding to medical therapy. An 18‑year‑old male patient with symptoms of blurred vision in the left eye for 1 month applied to eye clinic. The patient was taking intense treatment as a systemic and topical corticosteroid. All investigations were performed regarding the etiology of uveitis systemic. The etiology of uveitis could not be determined. In the patient history was working at the industrial zone, there was no history of trauma at eye and any systemic disease. In the eye examination, right eye to see 10/10, left eye see was at the level of hand movements. Intraocular pressures of the left and right eye were 9 and 6 mm Hg, respectively. Right eye was normal in fundus examination, left eye was not clearly evaluated due to the intense vitritis. At the slit‑lamp biomicroscope examination, right eye findings were normal, there was not deep and superficial conjunctival hyperemia in the left eye examination. Intense pigment in the anterior chamber, flaire, subcapsular lens pigmentation at epithelial level was present [Figure 1]. Two‑way head radiograph was asked from the patient. Intraocular foreign body was not detected due to superposition [Figure 2]. Metallic foreign body was detected at orbital computed tomography of intraocular 2.2 × 2.0 mm in size [Figure 3]. Intraocular foreign body was removed with 20G pars plana vitrectomy. Cataract extraction and intraocular lens implantation were performed in the same session. Postoperative intraocular pressure increased and YAG‑laser iridotomy was done. Intraocular pressure was normal during follow‑up. Vision in the left eye at the end of a 1‑year follow‑up of level was 1/10 level. In our patient, there was uveitis refractory to medical treatment. On examination, there was no evidence of foreign body in place. First, two‑way head radiographs were asked from the patient to investigate the intraocular foreign body. Due to the nonvisualization of foreign body with the probability of bone superposition, orbital bone computed tomography was requested. At the tomography there was foreign body in the left eye. In the presence of the intraocular foreign body, surgery action should be planned according to the duration of exposure, on 272
the nature, size, whether or not encapsulated, rather than in retinal toxicity. At patients with foreign bodies preserved and vision is clear, to follow the
Figure 1: Pigment epithelial deposits are observed under the lens capsule
Figure 2: Intraocular foreign body in two-way head radiograph was not detected due to the superposition
Figure 3: The presence of focal hyperdensity at orbital computed tomography inside the left bulbus oculi with a dimension of 2.2 × 2 mm (foreign body)
International Journal of Critical Illness and Injury Science| Vol. 4 | Issue 3 | Jul-Sep 2014
Letters to the Editor
patient with taking into account the risks of surgery is preferable.[3,4] In our case, due to the level of vision at hand movements and intense metallic foreign body with posterior uveitis, emergency pars plana vitrectomy was planned and performed. The foreign body was removed with forceps by preventing to drop it into the retina after implemented vitrectomy. As a result, intraocular foreign body should be kept in mind that in spite of medical treatment at a young age to relax in uveitis patients without evidence of any foreign body in the place of entry.
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Vatavuk Z, Pentz A. Combined clear cornea phacoemulsification, vitrectomy, foreign body extraction, and intraocular lens implantation. Croat Med J 2004:45:295‑8. Hasanreisoğlu B. In: Turaçlı E, editor. Eye traumas, 7th Ophthalmology course; 1987. p. 133 ‑43. Mester V, Kuhn F. Ferrous intraocular foreign bodies retained in the posterior segment: Management options and results. Int Ophthalmol 1998:22:355‑62. Soheilian M, Feghi M, Yazdani S, Anisian A, Ahmadieh H, Dehghan MH, et al. Surgical managementof non‑metallic and non‑magnetic metallic intraocular foreign bodies. Ophthalmic Surg Lasers Imaging 2005:36:189‑96.
Ali Akal, Tugba Goncu, Mustafa Atas1, Suleyman Demircan1, Ufuk Ozkan, Isa Yuvaci
Department of Ophthalmology, School of Medicine, Harran University, Sanliurfa, 1Department of Ophthalmology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Address for correspondence: Dr. Ali Akal, Department of Ophthalmology, School of Medicine, Harran University,Sanliurfa, Turkey. E‑mail: [email protected]
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
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