Electrophysiological findings in delayed discovery of a metallic intraocular foreign body in a child: case report
To report a case of a child with strabismus and delayed discovery of a metallic intraocular foreign body with good recovery of visual acuity and stereopsis with 36-month follow-up.
A 4-year-old girl was evaluated due to exotropia of right eye initiated 9 months before with progressive worsening. Visual acuity was 1.00 logMAR (20/200) in the right eye and 0.00 logMAR (20/20) in the left eye. Anterior segment evidenced a small paracentral corneal leukoma, posterior synechia and mild lens opacity in the temporal quadrant only in the right eye. Fundus examination in the right eye identified the presence of an intraocular foreign body, with appearance of metallic components surrounded by retinal pigmented endothelial cells atrophy. Full-field electroretinography (ERG) showed reduced amplitudes and delayed implicit times for both rods and cones in the affected eye. All tests were normal in the fellow eye.
Pars plana vitrectomy was promptly performed in the right eye, followed by phacoemulsification with intraocular lens implantation 4 months later due to worsening of the lens opacification. The full-field ERG was repeated after the surgical procedures. The ERG showed mild worsening of all responses in the right eye. After 36 months of follow-up, visual acuity was 0.20 logMAR (20/32) with improvement of the ocular misalignment and with 60 s of arc stereopsis with ERG responses unchanged.
In this young girl perforating ocular trauma with metallic material was lately diagnosed with strabismus as a sign of alert. Prompt surgical intervention and proper management were essential to provide reasonable visual function including some degree of stereopsis, even though retinal dysfunction characterized by ERG was persistent.
KeywordsOcular siderosis Metallic intraocular foreign body Ocular trauma Electroretinography
Vinicius Bergamo, Mariana Wisnesky.
FP was involved in writing the article, analysis and interpretation. LM was involved in surgical expertise, analysis and interpretation, final approval of the article. Paula Yuri Sacai involved in electrophysiological testing, analysis and interpretation, final approval of the article. SRS was involved in analysis and interpretation, final approval of the article. LSJ involved in surgical expertise, final approval of the article. AB was involved in electrophysiological testing, analysis and interpretation, final approval of the article.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
This study was approved by the Research Ethics Committee of the Federal University of Sao Paulo and adhered to the tenets of the Declaration of Helsinki.
The parents have given their written informed consent.
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Statement on the welfare of animals
This article does not contain any studies with animals performed by any of the authors.