Penetrating injury of the cornea by a barbed fish hook and i
Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...Now open: Certificate Course in Management of Covid-19 by Govt. Of Gujarat and PlexusMDKnow more...
An 11-year-old boy was struck in his right eye by a barbed fish hook while fishing with friends. The father cut off the fishing line and tried to remove the hook but failed. The child was brought to the hospital 12 hours after the injury. On examination, he had the best-corrected visual acuity (BCVA) of perception of light and projection of rays in all four quadrants in the right eye. The fish hook had penetrated the cornea obliquely, 3 mm away from the limbus at 9'0 clock. Slit-lamp examination of the RE revealed, a shallow irregular anterior chamber filled with exudates due to which tip of fish hook was not clearly visible [Figure 1]b. Fundus examination showed no fundal glow. B scan was not done as the patient was highly uncooperative for examination. It was a penetrating type of open globe injury of grade 4 involving zone 1 in the right eye. The left eye was normal.

The patient was given inj. Tetanus Toxoid 0.5 cc intramuscular Surgical Technique and started on oral antibiotics and advised for corneal FB removal and corneal tear repair under general anesthesia. Written consent was obtained from the parents for the removal of the fish-hook under general anesthesia (GA). Under GA, first, surgeons tried to remove the barbed fish hook with help of forceps through the same entry wound but the attempt was failed because of the lack of visibility of the tip due to exudates filled in irregular anterior chamber and incarceration of iris tissue in the tip. Then they made side port incision at 2 O clock at the limbus and anterior chamber tap was taken, then the anterior chamber was washed with help of saline and viscoelastic injected. The iris tissue plugged in the tip was separated with the help of the iris repositor. The entry wound was extended with help of a 15 number blade to facilitate smooth removal of the tip of a barbed fish hook. The configuration of the wound after enlarging it with the blade was curvilinear. After filling the anterior chamber with viscoelastic material, the fish hook was removed from the same wound by oblique movement (cut-it-out technique) without damaging adjacent structures, the wound sutured with six interrupted10-0 nylon sutures and side port hydrated. Bandage contact lens (BCL) was placed at the end as there was epithelial damage during removal of fish hook.

On the first postoperative day, the best-corrected visual acuity (BCVA) of perception of light and projection of rays in all four quadrants in the right eye. The corneal sutures were intact and the anterior chamber was showing the presence of exudative membrane with superior one-third filled with air bubbles. B scan of the right eye was normal with the attached retina. The patient was started on a topical antibiotic (Moxifloxacin 0.5% eye drops 6 times a day) and cycloplegic (Atropine 1% eye drops three times a day) and oral antibiotics were continued for a 1-week duration. After confirming micro reports of exudative material after 3 days (i.e., no evidence of infection), the patient was started on topical steroids (prednisolone acetate 1% eye drops 6 times a day). At 1 week of follow-up, the best-corrected visual acuity (BCVA) was the perception of light and projection of rays in all four quadrants in the right eye. The intraocular pressure was digitally normal. The BCL was removed. The eye showed resolving exudative membrane in the anterior chamber with damage to the iris at the pupillary margin and a traumatic cataract was visible. The parents were counseled for the need for cataract extraction in the future.

Source:https://www.ijo.in/article.asp?issn=0301-4738;year=2021;volume=69;issue=1;spage=153;epage=155;aulast=Bhalerao
Like
Comment
Share