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Retained cilia in anterior chamber in repaired post-traumatic corneal laceration
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  1. Yogita Gupta1 and
  2. Shilpa Viswanath2
  1. 1Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
  2. 2Department of Ophthalmology (RP Centre), All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Yogita Gupta; yogitagupta30{at}gmail.com

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Description

A 20-year-old male patient presented to our tertiary eye centre with post-traumatic cataract in the right eye, 3 months after penetrating trauma with metal wire while working with electric cables. The corneal laceration had been repaired soon after trauma elsewhere and the patient had some gain of vision post-surgery, following which the vision further deteriorated. On examination, there was a healed vertical corneal laceration, 7 mm in length, in the temporal part of the cornea with partially absorbed traumatic cataract, obscuring the visual axis and a temporal iridodialysis (5 clock hours extent). To our surprise, there was a cilium in the anterior chamber (AC) superiorly, with an end attached to the iris (figure 1). There was no associated active inflammation or AC reaction. The timing of dislodgement of cilia in the AC might be during the initial event of trauma or while the patient underwent primary repair of laceration (while doing sterile surgical draping, or while repositing the apparently viable uveal tissue inside the eye). We hypothesised that in our case, the cilium was probably missed during the primary repair of the corneal tear. The similar colour of the cilia and the iris tissue could be a possible explanation for this. The patient subsequently underwent lens aspiration with removal of the cilia in the AC. The postoperative period was uneventful and the patient achieved a best-corrected visual acuity of 20/30 at sixth postoperative week.

Figure 1

Clinical photograph (slit lamp biomicroscope image) of the right eye showing a retained cilia in the anterior chamber (yellow arrow) appreciated clearly in thin slit illumination, seen with post-traumatic repaired corneal laceration, post-traumatic cataract obscuring the visual axis and temporal iridodialysis. The colour of the cilia was noted to be similar to that of the iris tissue.

Possible mechanism of dislodgement of cilia was explained by Duke-Elder1 as follows. Fast-moving objects (eg, metal chips) result in reflexive closure of the eyelids only after the foreign body has contacted the conjunctiva or cornea, thus not giving ample amount of time for eyelashes to enter into the path of the foreign body. In contrast, eyelids reflexively close before a slow-moving object (eg, a wire) comes in contact with the ocular surface, and this allows them to enter the path of the foreign body. Our case also involved penetrating ocular trauma caused by a metal wire, which often is the cause of injury in majority of patients with intraocular cilia. Gopal et al2 conducted a case series of intraocular cilia post penetrating ocular trauma in which he stated that metallic wire was responsible for the injury in 6 of 11 eyes with intraocular cilia.

Limited trauma cases have been reported about cilia in the AC. Alami et al3 reported a similar case of post-traumatic cilia in the AC, where observation was done for the inert cilia. Yalniz-Akkaya4 demonstrated a cilium remaining inert for 50 years in the AC without causing any reaction in the AC. Post-traumatic intraocular cilia comprise nearly 0.4% of all intraocular foreign bodies.3

There are a few reports of posterior segment cilia in the literature. Ramos et al5 documented an extremely rare case of nine intraocular cilia embedded in the retina after a perforating ocular injury caused by a metal wire. Gupta et al6 documented similar case of two cilia embedded in the retina post penetrating ocular trauma. In both the cases, the cilia were removed through pars plana vitrectomy.

Learning points

  • Cilia may be accidentally implanted intraocularly during ocular trauma or during primary repair of corneal wound.

  • Careful slit lamp examination and examination under anaesthesia in operating room, just prior to the primary repair of corneal tear and also after completion of the repair, helps to avoid retaining of foreign bodies inside the eye.

  • Intraoperative anterior chamber irrigation and abscission of devitalised uveal tissue helps prevent contamination.

References

Footnotes

  • Contributors Both YG and SV contributed to the manuscript. YG contributed to the concept, design of the work, acquired data, and revised and reviewed the manuscript. SV interpreted the data of the work, drafted the manuscript and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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