8 mm long deep-seated "Corneal FB" removal strategies: Dr. Deepak Megur

Ajouté : 2026-05-25

[00:00:00]This film is intended for eye surgeons for training and education purposes.

[00:00:04]Viewer discretion is strongly recommended.

[00:00:09]>> [music] >> A 50-year-old lady presents with this clinical picture. She's a farmer and while working she had an injury to the eye and we have this long thin stick stuck into the cornea. It's measuring almost about 8 mm in length and it's horizontally placed.

[00:00:31]And the most challenging aspect is the one end is very close to the endothelium. It's almost 90-95% thickness into the stroma. Now the other end is the end from where it has entered and we can see the broken end of this foreign body. They attempted to remove it and we have a broken end here. That is the real challenge in dealing this patient. Now how do we plan surgery for her? Now this is a vegetative foreign body and uh it needs to be removed. It's not going to be inert. There's always a risk of infection, especially the fungal infection which is very common in our country. So it has to be dealt with immediately.

[00:01:13]So when you're planning surgery, there's always a risk of corneal perforation or a piece of this foreign body dropping down into the anterior chamber and that can complicate things much more. So our goal should be to remove this foreign body in total without breaking it in pieces and without perforating the cornea. Since the foreign body is so much deep-seated into the cornea, corneal perforation and incomplete removal of the foreign body are the major concerns when doing surgery.

[00:01:48]So the preparation is such that the in the worst-case scenario I'm also ready to deal with the corneal perforation and enter the anterior chamber if some of the foreign body drops in. So, we have all the sterile precautions taken. The surgery is being done in the OR with proper draping. The patient is blocked.

[00:02:08]And now I begin my surgery. See, the secret of removing these deep-seated intrastromal corneal foreign bodies it is to keep dissecting the corneal lamellae or stroma until the foreign body is laid bare. So, we want to minimize the resistance as you're trying to pull out the foreign body by cutting across the corneal stroma.

[00:02:31]And we don't want to have a very large wound as well. So, just in front of the foreign body because when we remove this foreign body, there's always going to be a scar removing and we don't want it to be an extensive scar.

[00:02:47]So, with minimal tissue [snorts] dissection, we need to have a situation where the foreign body can be pulled out without much of a side effects.

[00:02:57]So, the instruments which I'm going to use is tooth forceps and a 26 number needle to perform the dissection of the corneal tissue. So, the overlying corneal tissue of the foreign body is started with the 26 number needle itself. So, initially I make a cut on either side of the foreign body and then the tissue in front in between these two lines is being scraped off. So, this is gently continued to the entire span up to at least the 2/3 of the length of the the foreign body. The corneal lamellar dissection is continued.

[00:03:38]So, I find the 26 number needle is right instrument to do the dissection because you don't end up scraping up a lot of healthy cornea. Since the bevel is small, we don't end up damaging a larger structure.

[00:03:57]The secret is to keep on dissecting the corneal lamella until the majority of the length of the foreign body is laid bare.

[00:04:07]The problem is because the cornea is transparent, we'll not be sure that the dissection has gone deep enough.

[00:04:14]So, I need to continue to dissect until I can literally feel the foreign body with my needle.

[00:04:25]So, once I reach that stage, that is the stage when I would want to attempt pulling. I would resist the thought of pulling the foreign body much more earlier simply because it can break away. And if it breaks, again it becomes much more complicated. So, I'm just patiently waiting to reach the right plane before attempting the removal.

[00:04:50]The last 1/3 span of the foreign body are not scraped much. If the stroma over the 2/3 of the length of the foreign body is removed, that should be good enough to pull the foreign body out.

[00:05:01]That was my thought process.

[00:05:03]And at this stage, I think that the dissection has been sufficient enough.

[00:05:10]Very carefully, with the forceps I retract the one wall of the stroma so that there's no resistance to the removal of the foreign body. I use small forceps to grasp the foreign body.

[00:05:26]My concern was whether I'll be able to grasp it without breaking it. A combination of being a little gentle and also firm, I think eventually I got a good hold of it. And very slowly and deliberately, the foreign body was then gently pulled away along the same track within which it was embedded.

[00:05:49]There's a small piece left here. I go in and pull it out as well. So, I want to ensure that the wound does not harbor any remnants of the foreign body.

[00:06:03]After inspection, I'm going to put in Betadine drops to ensure that the sepsis is taken care of. The patient is put on antifungal eye drops and antibiotics.

[00:06:14]And 1 week later, this is how the eye looks. There's There's a corneal scar, but thankfully it is just a millimeter below the center of the pupil on the visual axis. The patient is reasonably happy with the outcome, and that was it.

[00:06:31]Deep-seated intracorneal foreign bodies can be a challenge, and the secret is very deep dissection of the corneal stroma over the corneal foreign body.

[00:06:43]This ensures that when you're trying to pull it out, there's least resistance for it, and then you can pull it out without breaking it in the stroma. So, that was it. Thank you for watching, and hope you found this helpful.