Management of a Large Metal Intraocular Foreign Body

In this surgical video, Drs. Felfeli and Mandelcorn demonstrate removal of a large, metal intraocular foreign body (IOFB) through a corneal incision. The patient was a young male who had been seen a month earlier for a healing corneal abrasion. On examination, there was a dense vitreous hemorrhage and a subtle iris transillumination defect suspicious for an occult IOFB. A CT scan confirmed that it was a 17-mm IOFB that extended from the inferior posterior iris to the posterior pole. Intraoperatively, the traumatic cataract was removed along with the ruptured capsular bag. Given its size, care was taken to rotate the IOFB within the vitreous cavity to limit damage to the peripheral retina. After trying to extract the IOFB through a smaller sclerotomy, it was removed through a corneal incision and the pupil. Endolaser was applied, silicone oil tamponade was placed, and the patient was left aphakic. Subsequently, silicone oil was removed, and an IOL was placed and suture fixated to the iris given the absence of capsular support with a final vision of 20/30. This case highlights the importance of a thorough history and examination for patients suspected of having an IOFB.

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