Case 24: Perforating Zone I and III Open Globe Injury with Traumatic Cataract, Iris Loss, and Metallic Foreign Body Removal
A 47-year-old man presented with a perforating open globe injury of the left eye following a tire explosion. Upon examination, a Zone I full-thickness corneal laceration with lens violation was noted on examination. Orbital computed tomography (CT) imaging showed a “U-shaped” radio-opaque intraocular foreign body (IOFB). After repair of the Zone I corneal laceration, pars plana lensectomy and vitrectomy was performed. However, the IOFB was unable to be located during vitrectomy. Further exploration revealed a posterior scleral exit wound with the metallic foreign body straddling the sclera. This case demonstrates that extraocular migration of IOFBs may occur during vitrectomy due to intraocular pressurization and an occult exit wound where the IOFB retracted into the globe. Perforating through-and-through injuries should be suspected if the IOFB cannot be identified during vitrectomy. The patient subsequently underwent pupilloplasty and a scleral fixated intraocular lens 1 year later, and vision improved from presenting vision of hand motions to 20/25 at 3 years of follow-up.
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