LAUSR

For the last five decades, pars plana has been the preferred route for extraction of intraocular foreign bodies worldwide [1], but the introduction of combined phaco and sutureless pars plana vitrectomy paid attention to the limbal route as a safe and effective route for extraction of intraocular foreign bodies. Comparing the limbal route versus the pars plana route, it is noted that the limbal route is more advantageous in that it is avascular, does not need enlargement in most cases, allows visually controlled delivery of the intraocular foreign body from the posterior pole to the limbal exit, in contrast to the hidden part behind the iris when using the pars plana route, and poses no relation to the vitreous base, thus minimizing the risk of creating a peripheral retinal break during extraction of intraocular foreign body. In my experience, the indications for use of the limbus as a route of extraction for intraocular bodies includes cases associated with lens injury and some cases of retained intraocular foreign bodies with intact lens in which the patient has preexisting cataract or the foreign body is too large to be delivered through the pars plana. In the last 3 years, 21 cases of retained intraocular foreign bodies were managed using 23-gauge and 25-gauge sutureless pars plana vitrectomy with extraction of the foreign body through the limbus. The technique entails watertight closure of the foreign body entry site when needed, staining of the ruptured anterior capsule (in cases associated with lens injury) followed by capsulorhexis of the remaining intact portion of the anterior capsule, phaco-suction of the lens matter, aspiration and irrigation of the cortical matter, pars plana vitrectomy with peeling of the posterior hyaloid, extraction of the foreign body through the limbus, diathermy to the bleeding points when needed, internal limiting membrane peeling to prevent the occurrence of postoperative ILM wrinkling maculopathy, vitreous base indentation and shave for de-