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Optimization of detection of intraocular foreign bodies


Presented The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine

Kogan M.B.

The study is focused on improving the efficacy of diagnosis for trauma-related changes in the eye globe (blunt trauma, penetrating injury with/without intraocular foreign bodies) by using near-infrared transpalpebral transillumination (NIR TPT).

For this purpose, an ex vivo experiment was performed in 10 enucleated cadaveric human eyes with choroidal melanoma, which showed that NIR TPT enabled to visualize hard-to reach intraocular structures, in particular, the ciliary body pars plicata and pars plana bounded by the ora serrata. Optimal visualization of the ciliary body pars plicata and pars plana limited by the ora serrata can be reached by using an incoherent light-emitting-diode light source with a dominant wavelength of 940 nm, i.e. in infra-red light. The ex vivo experiment on a traumatic eye injury model demonstrated that NIR TPT enabled visualization of damage to the iris and sclera as well as visualization of various types of intraocular foreign bodies (IOFBs) in the anterior segment. NIR TPT was found not only to visualize IOFBs but also to determine the localization of scleral shadows of IOFBs in relation to ciliary body structures.

The study assessed 50  patients with penetrating injuries: 50 eyes (50 patients); of them, 30 patients were with the proved presence of IOFB in the anterior segment (conjunctiva, cornea, limbal and paralimbal parts, iris, ciliary body, lens). The fellow eye was intact. In 20 patients, the presence of IOFB was not confirmed. Exclusion criteria were occasions of penetrating injuries with IOFBs in the posterior segment of the eye. It was found for the first time that, due to the absorption reflection and refraction features of the near-infrared light (940 nm wavelength), NIR TPT made it possible to visualize IOFBs, independently on their nature (metal, stone, wood), localized in the anterior segment of the eye, also in the presence of opaque media. Based on the experimental and clinical studies, a method of IOFB visualization in infrared light was developed (Patent of Ukraine No134645).

 Analysis of the developed method of NIR TPT made it possible to optimize the diagnosis for patients with penetrating injuries by: 1) visualizing IOFBs in the anterior eye, which are hard to detect; 2) detecting both X-ray positive and X-ray-negative foreign bodies; 3) identifying small (from 0.5х1х1mm) IOFBs; 4) visualizing IOFBs in the presence of opaque media (corneal haze, swelling cataract).  NIR TPT enabled detecting the projection of the ciliary body in all patients as well as detecting IOFBs in the projection of the ciliary body, which made it possible to choose the optimal surgical tactics.

Using a developed noninvasive method of NIR TPT together with radiographic and ultrasonic methods of visualization increased the efficacy of IOFB detection in the anterior segment of the eye, in general, by 10% due to both increased detection of X-ray-negative IOFBs and identification of small (less than 1 mm) IOFBs.

Number of publications: 7 (total number of references to publications / h-index of work, according to databases is: Web of Science - 0/0, Scopus - 4/1, Google Scholar - 10/2), 1 patent of Ukraine for useful model.