Removal of an intraocular foreign body from the optic nerve head

A 29-year-old man sustained a metallic (98% iron) foreign body in the optic nerve head, which resulted in a massive vitreous hemorrhage and a secondary branch retinal artery occlusion. An initial pars plana vitrectomy was successful in removing the vitreous hemorrhage, but numerous attempts with pars plana and intravitreal electromagnets failed to dislodge the foreign body. A second operation using a microscalpel and foreign body forceps with the bimanual pars plana technique was successful in removing the steel foreign body from the optic nerve-head.