First Usage of Nitinol Stone Basket For Intraocular Foreign Body (IOFB) Removal In Hospital Canselor Tuanku Muhriz (HCTM) UKM

5th January 2024

Good New Year news to share on the management of glass injuries to the eye:

The removal of a large glass piece of intraocular foreign body (IOFB) from the vitreous gel of an eye, utilising a Nitinol stone basket was performed successfully for the first time at the private wing (UKM Specialist Centre) of Hospital Canselor Tuanku Muhriz on Thursday, 4 January 2024, by Professor Dr Mae-Lynn Catherine Bastion, vitreoretinal surgeon and senior consultant ophthalmologist from Department of Ophthalmology, Hospital Canselor Tuanku Muhriz and Faculty of Medicine, Universiti Kebangsaan Malaysia. The Nitinol stone basket was sourced from the Urology Unit, Department of Surgery, headed by Associate Professor Dr Fam Xeng Inn, as conventional eye forceps were unable to grasp the large and slippery piece of glass. She was assisted by her registrar, Dr Lee Jing, who manually closed the basket once the glass piece, in the form of a rod with 2 sharp ends measuring 14 x 3.4 x 3 mm was manoevered using active suction into the basket by Prof Mae-Lynn.

The patient, a 69-year-old businessman from Hong Kong, who had received multifocal intraocular lenses (MFIOLs) at another centre previously in both his eyes, was boiling a bottle in a pot, when the bottle exploded. The explosion sent sharp glass shards into his right eye, right eyelids, right arm and right hand causing laceration wounds that were sutured following removal of the glass. Unfortunately, although the laceration of the cornea (clear, transparent tissue in front of the dark iris) was repaired successfully at the emergency surgery, the sharp glass piece which was initially seen at the lower part of the front compartment (anterior chamber) of the right eye, could not be grasped by conventional Kelmann forceps, slipping behind the MFIOL. It subsequently dropped into the vitreous gel at the back part of the eye.  The CT scan reported a glass foreign body (IOFB) measuring 9 x 4 mm located in the vitreous gel of the eye (Figure 1). The large size reported prompted the preparation of a Nitinol basket prior to the surgery due to several other reports from overseas with similar glass IOFB in the literature.

Surgery in the form of 23-gauge (0.6 mm) vitrectomy to remove the cloudy vitreous gel was performed under general anaesthesia. The glass piece was seen resting on the lower vitreous gel (Figure 2). Heavy liquid was injected to protect the important areas of the macula and optic nerve. A separate incision was made in anticipation of the large size of the IOFB. The largest eye forceps available attempted but failed to grasp the thinnest and slippery end, so the Nitinol stone basket was inserted (Figure 3). The IOFB was manoevered into the basket, which had a large open diameter that fit over one of the ends. The opening was closed around the IOFB securely, and it could be delivered through a large incision measuring 6 mm at the pars planar (Figure 4). The retinal lacerations caused by the IOFB were lasered and silicone oil was injected to stabilise the retina. His MFIOL was stable and could be left in place to function.

He reported improvement in his vision on day 1, noticing absence of the floaters that had initially clouded his vision. All wounds were intact and the intraocular pressure was within normal range on medications. He was discharged with plans to remove the silicone oil in 6 weeks’ time. Given the good condition of the right macula and optic nerve, the potential to recover his vision for balance with the fellow eye is anticipated to be good. This case is the first time cross-disciplinary instruments included the usage of fine Urology instruments to aid Eye (Vitreous) surgery at HCTM @ UKMMC.

Figure 1: CT scan showing the glass foreign body (IOFB) measuring 9 x 4 mm located in the lower vitreous gel (arrow)



Figure 2: Picture taken during the surgery shows the long and sharp glass IOFB resting at the lower aspect of the retina


Figure 3: The Nitinol stone basket used in Urology surgery is long and can be inserted up the narrow passage of the ureter to grasp ureteric stones which has a hand-held controller to close the basket when the stone has been captured. The opening of the basket allows stones up to 1 cm in smallest diameter to be grasped.



Figure 4: The Nitinol stone basket (arrow) securely grasps the long, sharp glass IOFB and delivers it from the eye through a wound created in the upper sclera (pars plana)