This patient sustained an open globe injury where a metallic foreign body pierced the cornea and the lens capsule and embedded itself in the crystalline lens. Our guest surgeon does a great job with this tough case. The question is do you follow the old dogma of leaving the eye temporarily aphakic and then coming back to the operating room in the future for secondary IOL implantation? Or are you willing to insert the IOL now?
Removal of an intra-lenticular metallic foreign body requires meticulous microsurgical technique to preserve ocular structures and minimize postoperative complications. A continuous curvilinear capsulorhexis is performed to to encompass the rupture of the anterior lens capsule. Phacoemulsification is used to remove surrounding lenticular material if the foreign body is embedded deeply. Using intra-ocular forceps or a magnet (if the object is ferromagnetic), the foreign body is carefully extracted to avoid posterior capsular rupture. In cases with capsular compromise, a posterior chamber intraocular lens may be placed in the sulcus with optic capture. Thorough irrigation and aspiration are performed to ensure no residual lens material or metallic fragments remain. Postoperatively, topical antibiotics and corticosteroids are prescribed, with close follow-up to monitor for inflammation, elevated intraocular pressure, or retinal complications.