ASOCT characteristics and management of incense stick injury using vitreoretinal forceps

Dear Editor, We read with interest the article by Sharma et al.[1] on the retrieval of a deep corneal stromal wooden foreign body using vitreoretinal forceps as a scoop. We dealt with a similar scenario of trauma with an incense stick, which created a tract and penetrated the full-thickness cornea. Slit lamp biomicroscopy showed a 3.5-mm-long stick creating a tract, embedded in the stroma, and protruding into the anterior chamber. Anterior segment optical coherence tomography (ASOCT) showed the tract and foreign body as a hyper-reflective echo in the stroma with back shadowing and its entry into the anterior chamber breaching DM [Fig.1]. Vertical line scans showed DM breach and its entry into anterior chamber. DM breach is marked by inward curling of DM.[2]Figure 1: (a) Slit-lamp photo of the left eye (OS) showing an incense stick embedded in the cornea partly in stroma and anterior chamber well delineated in slit view. (white box). (b) Spectral domain AS-OCT of OS showing area of high reflectivity in the anterior to mid stroma showing the track (white arrow) with backshadowing (blue arrows), confirming the presence of foreign body. (c) Inward curling of DM confirms the DM breach (yellow arrow). (d) 3.5 mm size of incense stick (red circle)A surgical removal was planned. Intra-operatively, a side port entry was made just parallel to the orientation of the FB. ILM peeling forceps were used to grab and dislodge the FB from the inner lip of the corneal entry and were removed from the anterior chamber after enlarging the side port. We chose to use the internal approach for foreign body removal as it was more accessible from the anterior chamber as compared to the external approach, which would carry the risk of extending the tract into a larger one and inducing astigmatism. The authors have emphasized the use of a vitreoretinal FB forceps leg as a scoop to remove intrastromal corneal FB as this maneuver will prove to be an important and simple technique for eye surgeons who frequently encounter such corneal foreign bodies. We recommend the use of ILM peeling or any long micro-forceps for holding foreign bodies that have already penetrated DM and protruding in the anterior chamber for firm grip and easy access for removal from the internal approach.[2] Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.