Good visual rehabilitation in a patient without traumatic cataract surgery after removal of a ferrous intravitreal foreign body by external magnetic extraction through a pars plana incision: A case report

Background: There is an increasing trend toward performing pars plana vitrectomy and simultaneous cataract extraction in the management of patients with intraocular foreign bodies and traumatic cataracts. Herein, we describe a case of good visual rehabilitation in a patient without traumatic cataract surgery after removal of a ferrous intravitreal foreign body (IVFB) using an external approach. Case presentation: A 44-year-old man presented to our ophthalmology department because of decreased visual acuity after a penetrating trauma to the left eye 2 days earlier. Best-corrected visual acuity (BCVA) was 20/200. An examination revealed a midperipheral self-sealing corneal penetrating wound at the 5 o’clock position, in addition to a mild inflammatory reaction in the anterior chamber. Pupil dilation revealed peripheral anterior and posterior capsular violations, with subcapsular opacity involving the visual axis. A small metallic-like foreign body suspended in the vitreous was confirmed by B-scan ultrasonography and orbital computed tomography. Retinal injury and vitreous hemorrhage were excluded by B-scan ultrasonography and binocular indirect ophthalmoscopy. This IVFB was successfully removed by external magnetic extraction through a pars plana incision. At the 2-week follow-up, the traumatic cataract was partially resolved, and BCVA improved to 20/125. At the 3-month follow-up, the traumatic cataract was mostly resolved, the visual axis was clear under a normal pupil, and BCVA improved to 20/20. Peripheral localized lens opacity was found after pupil dilation, and a fundus examination revealed no obvious abnormality. Conclusions: The size and location of an intraocular foreign body and the location and extent of lenticular involvement and associated injuries should be considered in patients with intraocular foreign bodies and traumatic cataracts. In selected patients with a small ferrous IVFB and a localized traumatic cataract, a good visual outcome may be achieved with minimal surgery. Keywords: Intravitreal foreign body, Traumatic cataract, External approach, Case report.