Intravitreal Cotton Fiber Foreign Body after Intravitreal Injection

Iatrogenic intraocular foreign bodies (IOFBs) are rare findings to be associated with sterile intraocular procedures. They are usually observed in the anterior chamber, introduced during cataract surgery, while IOFBs in the posterior segment of the eye are very rare. We report a case of a patient with intravitreal cotton fiber foreign body associated with intravitreal anti-VEGF injection. An 86-year-old male patient presented with sudden, painless loss of vision in his right eye. Examination of the fundus revealed dense subretinal hemorrhage (SRH) involving the macula and causing deterioration of vision. Examination also revealed a fiber foreign body in the posterior vitreous of the same eye. The patient had known neovascular age-related macular degeneration and had been treated with regular anti-VEGF intravitreal injections for the past 6 years. Due to SRH in his right, the only functioning eye, we decided to perform a pars plana vitrectomy. During the surgery, we were able to touch the intraocular fiber foreign body with surgical instruments and it proved to be soft, flexible, and relatively compact. Given the white color and composition, our conclusion was that it was a cotton fiber thread. Identical material is an integral part of cotton tips used to disinfect the conjunctiva with povidone iodine just before administering an intravitreal injection. We hypothesize that such a cotton tip was the source of the foreign body. Careful preparation of the operative field and selection of high-quality surgical materials are mandatory in avoiding such a complication.