Occult nonmetallic intraocular foreign bodies presenting as fulminant uveitis: a case series and review of the literature
A 36 year old man presented with decreased vision, pain, epiphora, and photophobia in the left eye (OS) after being hit in the eye by a blackberry bush. An external ophthalmologist treated him with oral and topical corticosteroids and cyclopentolate before referring him 2 weeks later. His left eye had hand motions visual acuity (VA) and an intraocular pressure (IOP) of 14. Slit lamp examination revealed a small subconjunctival elevation inferotemporal to the limbus, 4+ pigmented anterior chamber (AC) cell, a fibrin clot, and dense vitritis precluding clear fundus visualization. B-scan ultrasonography identified a hyper-reflective area that is concerning for a foreign body (). Examination of the right eye (OD) was unremarkable. It was decided to proceed with surgical intervention to address the presumed endophthalmitis and possible IOFB. The patient underwent vitrectomy, endolaser, and scleral buckle for a limited retinal detachment discovered intraoperatively in the area of the external injury. A small thorn which extended from the sclera, through the retina, and into the vitreous was discovered in this same area of the retinal detachment and was removed ( and ). He received intraoperative intravitreal injections of vancomycin, voriconazole, and ceftazidime. He was also treated postoperatively with topical atropine, polymyxin/trimethoprim, and prednisolone acetate along with oral moxifloxacin 400 mg daily and voriconazole 200 mg twice daily. Vitreous polymerase chain reaction (PCR) and cultures both revealed Staphylococcus epidermidis. Seven months following the initial surgery and 4 months following cataract removal and lens placement, the patient was pain-free with best corrected VA of 20/25+1.