Endophthalmitis, IOFB, and Lower Retinal Detachment in an 11-Year-Old Patient

Dr. Ahmed Roshdy Alagorie presents a case of an 11-year-old old boy with endophthalmitis, a large intraocular foreign body (IOFB), and lower retinal detachment after repair of a ruptured globe (visual acuity was PL).

Starting with core vitrectomy, posterior vitreous detachment (PVD) was induced; however, due to a poor view, the decision was made to switch to pars plana lensectomy. The PVD was completed, and a peripheral vitrectomy was performed. After attempting to gently free the IOFB from its impaction inside a dense amalgam of exudation, an opening was created in the anterior capsule with the cutter. Holding the IOFB with the high vacuum of the cutter allowed it to be carried it over the iris and, with the help of the magnet, extracted through the corneal incision. The incision was cleaned of exudation over the macula with the vacuum of the cutter as much as possible, and the dense exudate surrounding the IOFB was very carefully removed (as it was adherent to the detached lower retina). This was followed by diathermy to the retinal tear, fluid–air exchange, laser, and application of silicone oil.

Three months later, during silicone-oil removal, a 3-piece IOL was implanted in the sulcus. Because the capsule was fibrotic, it was not possible to create an opening in the capsule with the cutter. Instead, viscoelastic was injected below the IOL, and an MVR blade was used to create an opening. Silicone oil was removed, and the edge of the opening was trimmed with the cutter to create a perfect space through which to perform posterior optic capture of the IOL. In the end, the retina was attached, and VA improved to 0.2.

Financial Disclosures: Dr. Ahmed Roshdy Alagorie discloses no financial relationships.