Penetrating ocular injury due to a fish hook: Surgical removal
Chen SDM, Chiu D, Patel CK
Oxford Eye hospital, Oxford UK
Correspondence to: Mr Simon Chen, Oxford Eye hospital, Woodstock rd, Oxford OX2
6HE, UK. E-mail: s-chen@rocketmail.com
Accepted for publication: 1st August 2003
Surgical removal of a barbed fish hook from the anterior segment by retracting the fish hook out via an enlarged wound. The lens is protected with a glide in the anterior chamber. |
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Introduction
Penetrating ocular fish hook injuries are a rare yet potentially blinding form of ocular trauma. The vast majority occur in young males, with left eye involvement being more common.1 The majority of injuries involve the lids or anterior segment, although posterior segment injury has also been reported.2
In the case demonstrated in this video, a 38 year old male sustained a penetrating right eye injury with a barbed fish hook whilst fly fishing in a pond.
His best corrected visual acuity at presentation was counting fingers. A barbed fish hook was visible in the anterior segment with a full thickness central corneal entry wound adjacent to the visual axis. The tip of the hook was in the anterior chamber and the visible portion of the lens and anterior capsule appeared clear. The patient underwent surgical removal of the fish hook under general anaesthesia.
Technique
A paracentesis was made. This was followed by injection of viscoelastic (Viscoat) to deepen the anterior chamber and provide corneal endothelial protection. Next a 3.2 mm corneal section was fashioned to allow insertion of a plastic lens glide passed between the anterior lens surface and the fish hook, thus minimising the risk of inadvertent lens damage during subsequent manipulation of the fish hook.
An attempt was made to gently remove the fish hook by passing it backwards along the original entry tract. However, this was not possible due to the presence of a barb.
A diamond blade was then used to extend the length of the initial entry wound thus facilitating easy removal of the fish hook and barb by rotating it backwards along its original entry path. The entry site and corneal section were closed with 10/0 nylon sutures.
Antibiotic cover with intravenous cefuroxime (750mg) was administered.
The post operative course was uneventful. On review 9 months later, mild residual corneal stromal scarring and a focal anterior cortical lens opacity were present but not involving the visual axis. The patient was asymptomatic and the unaided visual acuity was 6/6 with all sutures having been removed.
Comment
A number of different techniques have been suggested to remove fish hooks from the anterior segment of the eye. The ‘back-out’ technique involves retracting the hook out through its entry wound and is unsuitable for barbed fish hooks as excessive tissue damage may be caused.
An alternative method for dealing with barbed fish hooks is to transect the hook and barb with sterile wire cutters,3 thus allowing the resultant barbless hook to be removed using the back-out technique.
The technique of barbed fish hook extraction demonstrated in this video involves a controlled enlargement of the primary wound, followed by retracting the fish hook out via the enlarged wound. The use of a protective lens glide minimises the added risk of intraoperative lens damage.
This method also has the advantage of avoiding the additional intraocular manipulation of the fish hook and possible further trauma involved in cutting the barb. It also obviates the need for specialised wire cutting equipment.
Because of the associated use of bait and exposure to marine flora, ocular fish hook injuries represent contaminated wounds and require prompt surgical repair and use of broad spectrum antibiotics.
With prompt and appropriate management, penetrating ocular fish hook injuries of the anterior segment have the potential to obtain attain excellent visual results.
References
1. Aiello LP, Iwamoto M, Guyer DR. Penetrating ocular fish-hook injuries. Surgical management and long-term visual outcome. Ophthalmology.1992; 99(6):862-6
2. Mandelcorn MS, Crichton A. Fish hook removal from vitreous and retina. Case report. Arch Ophthalmol. 1989;107(4):493
3. Bartholomew RS, Macdonald M. Fish hook injuries of the eye. Br J Ophthalmol.1980;64(7):531-3.