What is hidden behind hemophthalmos?
Authors:   S. Fyodorov Eye Microsurger y Federal State Institution, Moscow, Russian Federation, Alferova E.A. , Kakunina S.A. ,   S. Fyodorov Eye Microsurger y Federal State Institution, Moscow, Russian Federation, Shantukova Z.T. ,   S. Fyodorov Eye Microsurger y Federal State Institution, Moscow, Russian Federation
Published: February 2025

Objective. To demonstrate a clinical case of combined surgical treatment of a patient with penetrating trauma of the eyeball.

Methods. Patient G., 42 years old, applied to the Scientific and Technical Complex "Microsurgery of the Eye" in Moscow with complaints of a sharp decrease in visual acuity of the left eye. It is known from the anamnesis that 6 months before the application he received an injury to the left eye while mowing the grass with a trimmer without using protective glasses. He was examined by an ophthalmologist at the place of residence, referred to the Scientific and Technical Complex "Microsurgery of the Eye" with the diagnosis: OS "Hemophthalmos. Traumatic cataract".

At the place of residence, there was no suspicion of the presence of an intraocular foreign body. According to the examination data at the Scientific and Technical Complex of the Moscow Eye Institute: visual acuity OS – pr.lucis certae (proectio lucis certae), intraocular pressure (IOP) (pneumotonometry) 9 mm Hg, B-scan: OS – membranes are adjacent, in the vitreous body there is an acoustic picture of hemophthalmos, in the posterior pole a foreign body of high echo density with an acoustic track, measuring 0.8 × 2.0 mm, is visualized. To confirm the diagnosis, the patient was referred for computed tomography of the orbits, which revealed the presence of a foreign body up to 2.5 mm in diameter in the posterior parts of the vitreous body of the left eye. Based on the studies conducted, a combined surgical intervention was planned, including phacoemulsification with implantation of an intraocular lens, followed by endovitreal intervention and removal of the foreign body. Due to the presence of total hemophthalmos, the surgical treatment tactics were determined intraoperatively.

The features of the first stage of the operation (phacoemulsification) include the presence of a point scar in the peripheral part of the cornea at 10 o'clock on the conventional clock face (the entry point of the foreign body), the presence of iridocorneal synechiae separated by a Koch spatula. Intraoperatively, at the stage of removing the cortical masses, a peripheral defect of the posterior capsule of the lens was detected at 10 o'clock.

During the second, endovitreal, stage of the intervention, anterior vitrectomy, layer-by-layer central and peripheral vitrectomy were performed. After removal of the organized heme clots, an intraocular foreign body was found, which was a metal fragment with sharp edges, localized upward and inward from the optic nerve head, on the surface of the posterior hyaloid membrane of the vitreous body, between the retinal vessels. It is noteworthy that the foreign body was not fixed to the internal membranes, therefore, in order to protect the macular area from trauma, a bubble of perfluoroorganic compound (PFOC) was introduced through the hole in the hyaloid membrane. Through the defect of the posterior capsule of the lens, the fragment was brought out into the anterior chamber using straight endovitreal forceps, where it was captured by a second endovitreal forceps and brought out through the main corneal incision. After removal of the foreign body, peripheral vitrectomy was performed. The place of contact of the foreign body with the retina was examined for the presence of retinal ruptures, blocked using endolaser coagulation. At the final stages of the operation, a three-part intraocular lens was implanted, PFOC was removed by passive aspiration, and the sclerotomy incisions were sealed with interrupted sutures.

Results. On the 1st day of the postoperative period, a standard ophthalmological examination was performed: visometry OS = 1.0 without correction, IOP (pneumotonometry) 17 mm Hg, B-scan OS - avitria, membranes are adjacent. At the control examination 1 month after the operation: the patient's condition is stable, no complaints, visometry data correspond to those obtained earlier.

Conclusions. The combined surgical treatment, including phacoemulsification with implantation of an intraocular nicking injury of the eyeball.

Key words: hemophthalmos, intraocular foreign body, vitrectomy