Ng Tuck Chun, Goh Pei Li
Ophthalmology, Miri General Hospital, Miri, MYS.
Emergency and Trauma Department, Miri General Hospital, Miri, MYS.
Cureus. 2019 Sep 24;11(9):e5737. doi: 10.7759/cureus.5737.
A 29-year-old man was brought to the hospital for treatment after an alleged workplace accident. Initial assessment revealed only mild chest injury and mild confusion, with no other injury. His vision was unaffected with no relative afferent pupillary defect. A computed tomography scan of the brain, performed to rule out brain injury, revealed an incidental finding of a foreign body in the left intravitreal cavity with no other significant findings. Further examination of his medical history revealed that he had experienced a trauma one year earlier, in which his left eye was pierced by a projectile. Immediately post-trauma, his vision had been reduced significantly, but improved over the next few weeks without medical treatment. The current examination of his left eye revealed a small hyperpigmented area on the sclera, representing the point of entry of his previous wound. An encapsulated foreign body was observed in the inferior intravitreal cavity, surrounded by retinal atrophy, and a normal posterior pole. He was managed conservatively without complications. The decision to remove a missed retained intraocular foreign body is complex and depends on multiple factors, including surgical difficulty and the composition, size, and location of the retained foreign body. Removal should be weighed against the possible serious complications of intraocular surgery. If removal is surgically difficult, or the retained material is inert, patients can be managed conservatively with regular monitoring.
一名29岁男性在一场据称的工作场所事故后被送往医院治疗。初步评估显示仅有轻度胸部损伤和轻度意识模糊，无其他损伤。他的视力未受影响，没有相对传入性瞳孔障碍。为排除脑损伤而进行的脑部计算机断层扫描显示，偶然发现左玻璃体内有异物，无其他显著发现。进一步询问他的病史发现，他在一年前曾经历一次外伤，左眼被射弹穿透。外伤后即刻，他的视力显著下降，但在接下来的几周内未经治疗有所改善。目前对他左眼的检查发现巩膜上有一个小的色素沉着区域，代表他之前伤口的入口点。在玻璃体内下方观察到一个包裹性异物，周围有视网膜萎缩，后极正常。他接受了保守治疗，没有出现并发症。决定取出遗漏的眼内异物很复杂，取决于多个因素，包括手术难度以及留存异物的成分、大小和位置。取出应与眼内手术可能的严重并发症相权衡。如果手术取出困难，或者留存物质无活性，可以对患者进行保守治疗并定期监测。
