Retrieval Of Corneal Stromal Wooden Foreign Body

This report highlights the successful surgical retrieval of an intrastromal wooden foreign body in a pediatric patient with a history of ocular trauma. The case emphasizes the significance of early diagnosis, prompt surgical intervention, and the role of anterior segment optical coherence tomography (AS-OCT) in detecting and monitoring corneal foreign bodies. The report aims to contribute to the existing literature on the management of retained intraocular foreign bodies, particularly in resource-limited rural settings.

This case was managed at a specialized ophthalmology center receiving referrals from rural regions of Guatemala. The patient, a 10-year-old girl from San Marcos, a rural area with limited access to advanced eye care. The patient subsequently reported progressive visual impairment, which was first noticed by schoolteachers, prompting further evaluation. A comprehensive ophthalmic assessment and surgical intervention were performed under sterile operating room conditions.

A 10 year old presented with a visual acuity was 20/400 Snellen. In the initial evaluation with slit lamp biomicroscopy there was evidence of blefaroespasm, mild conjunctival hyperemia (360 degrees). Corneal lamellar laceration (5 mm)with a dense stromal infiltrate (5×4 mm), corneal edema surrounding the lesión. An anterior OCT showed an hyperreflective, dense stromal image with posterior shadowing indicative of an intraestromal foreign body. Due to the suspicion of a retained foreign body, the patient was immediately taken to the operating room for surgical intervention under general anesthesia.

The 10-yearl od patient was put under general anesthesia. A Sideport 15-degree ophthalmic micro-surgical blade was used to access the corneal stromal tract. The foreign Body Extraction: A portion of the retained vegetable foreign body was removed using the blade tip as a scooping instrument.  The lamellar laceration was irrigated and white purulent material came ut of it. Further manipulation allowed additional foreign body material to be pushed into the anterior chamber and was successfully retrieved using intraocular retina forceps. The corneal laceration was closed with two interrupted 10-0 nylon sutures.  A follow-up Anterior Segment OCT was performed to assess corneal healing, suture depth, and foreign body clearance.

The patient underwent successful surgical management for a corneal foreign body. Further follow-up is required to assess long-term visual prognosis and potential refractive rehabilitation. AS-OCT plays a crucial role in the evaluation of ocular trauma, particularly in detecting intrastromal foreign bodies and assessing the depth of corneal sutures. A thorough evaluation is especially critical in cases where the foreign body has been retained for an extended period, as in this patient’s case, where it remained for a month.   Additionally, AS-OCT is invaluable in post-surgical evaluation by determining suture depth and positioning, ensuring optimal corneal healing.