Large Glass Intraocular Foreign Body Removal with A Simple Slipknot:A Case Report

Large Glass Intraocular Foreign Body Removal with A Simple Slipknot:A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Large Glass Intraocular Foreign Body Removal with A Simple Slipknot:A Case Report Yi nan Gu, Zhitao Su This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9352609/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Open globe injuries with intraocular foreign bodies(IOFBs)are characterized by complexity and diversity.The removal of IOFBs poses a unique challenge to ophthalmic surgeons.Particularly for large or irregular non-magnetic IOFBs in the posterior pole, considerable difficulty exists.We report a novel technique of a simple slipknot construction by using 8 − 0 polyglactin suture (Vicryl, Ethicon) to remove IOFBs effectively and safely. Case presentation A 50-year-old healthy female sustained a left eye glass explosion injury while working without wearing goggles 8 days ago. Despite debridement and suturing, the patient still experienced blurred vision and was subsequently referred to the our ophthalmology department .An IOFB in vitreum was indicated by B-ultrasound and orbital CT,which was approximately 15mm in length and 4 mm in width, with a glass-like nature.We performed pars plana vitrectomy (PPV) combined with IOFB removal by utilizing a simple slipknot made with 8 − 0 Vicryl suture in the left eye for the patient, with no complications observed. Conclusion This kind of slipknot enables safe and rapid removal of IOFBs, featuring economical and simple to construct from readily available consumables,which make it particularly suitable for large and irregular IOFBs.The tight ligation effectively prevents accidental detachment of the IOFBs, thereby avoiding iatrogenic retinal injury. Intraocular foreign body Open globe injury Slipknot Suture Figures Figure 1 Figure 2 Figure 3 Background It has been reported that 10% to 41% of open globe injuries are associated with intraocular foreign bodies (IOFBs), with the majority localized in the posterior segment[ 1 , 2 , 8 ].This not only increases the risk of subsequent endophthalmitis and retinal detachment, which can determine severe vision loss (SVL)[ 3 , 4 ], but also indicates that prompt foreign body removal is warranted.The prognosis largely depends on the size, nature, and location of the IOFBs[ 4 ]. Epidemiological studies indicate that IOFBs predominantly occur in young and middle-aged adults of working age, with most cases presenting good pre-injury visual acuity[ 5 – 7 ]. Therefore, the prognosis of traumatic eye injuries is crucial for such patients.Historically, IOFBs were removed by external magnet together with scleral cut-down[ 8 ]. Currently, with the advancement of microsurgical techniques,surgical removal of IOFBs requires vitrectomy and extraction using a magnet or forceps[ 9 ]. However, such methods still face considerable difficulties in removing non-magnetic foreign bodies.Conventional forceps for IOFB removal have limited bite force, making them ineffective for large or irregularly shaped objects (e.g., glass). When the scleral incision for the IOFB is insufficient in length or the IOFB is too large for secure grasp, it may uncontrollably retract to the retina, causing iatrogenic retinal or even macular damage. Therefore, during IOFB procedures involving large or irregularly shaped objects, priority should be given to instruments and techniques that safely handle IOFBs of various sizes and properties, minimize surgical trauma, and are most readily available. Hearby,we describe a novel technique of a simple slipknot construction by using 8 − 0 polyglactin suture (Vicryl, Ethicon) to remove IOFBs effectively and safely. Case presentation A 50-year-old female patient was referred to our hospital in June 2023 .The patient had suffered a glass explosion injury on her left eye,with blurred vision for 8 days after debridement and suturing.The general condition was normal.Negative for other ocular trauma or prior surgical history.On presentation,the best corrected visual acuity (BCVA) was 20/20 in the right eye and CF/30cm in the left eye. Intraocular pressure (IOP) was 11 mmHg in both eyes.No abnormalities were observed in the anterior or posterior segment of the right eye.The left eye presented a 4 o'clock direction corneal laceration approximately 4mm in length combined with local sutures,and also accompanied by lens opacity, which induce poor visualization of the vitreous body and fundus(Fig. 1 A).Ultrasound and orbital CT confirmed the presence of a IOFB in the vitreous cavity(Fig. 1 B)(Unfortunately,the orbital CT was performed at the local hospital, and the images were not retained).The IOFB was approximately 15mm in length and 4 mm in width.In the setting of IOFB removal, a standard 3-port PPV was performed. After core-vitrectomy, the vitreous around the IOFB was partially removed to allow access of the suture loop to the IOFB.Perfluorocarbon liquid (PFCL) was used to keep the IOFB away from the macula (Figure. 2A,B), followed by resection of the peripheral vitreous.Then, a pre-constructed slipknot was prepared externally with 8−0 Vicryl suture to construct a loop structure(Fig. 2 C,D,also an additional movie file shows how to make a slipknot in more detail [see Additional file 1]).The suture loop was delivered into the vitreous cavity via the pars plana incision at the 10 o'clock position using micro intraocular forceps, and then placed the suture loop around the IOFB along its short axis with the assistance of endoillumination.One end of the slipknot was tightened by the assistant surgeon to secure the IOFB firmly(Fig. 2 E,F).Subsequently, the residual vitreous around the IOFB was removed with the vitrectomy cutter, and the IOFB was completely extracted via the scleral incision(Fig. 2 G,H).Finally, laser photocoagulation was performed on the retinal injured and degenerative areas, and the vitreous cavity was tamponaded with perfluoropropane (C3F8) gas.Postoperatively, the patient received anti-inflammatory and symptomatic treatment,and was followed up 1 day, 4 days, 1 month, 3 months after the surgery.At the follow-up of 1 month after the surgery, the BCVA of left eye was 20/63.No intraocular inflammatory reaction was observed and the retina was flat with the macular retinal structure showing normal morphology(Fig. 3 A-C).At the follow-up of 3 months after the surgery, the BCVA of left eye was 20/40.We then performed scleral intralamellar fixation of the intraocular lens (IOL).At the last follow-up,the BCVA of left eye had improved to BCVA 20/32,with well-centered IOL, well-attached retina and absence of proliferative vitreoretinopathy(PVR). OCT imaging revealed no significant morphological abnormalities in the macula.(Fig. 3 D-F). Discussion and Conclusions Recent advances in surgical techniques and instrumentation have significantly improved the management and removal of IOFBs. A variety of forceps, snares, baskets, and magnets have been developed,but the extraction of large, sharp, or irregular ones remains challenging for surgeons[10,10a].Nur Acar described an ACAR foreign body forceps,which were produced in Turkey[ 11 ].The advantage of this foreign body forceps lies in its ease of extracting spherical IOFBs,but they need to be purchased beforehand.ManeeshBapaye et al reported a claw-shaped forceps,which can remove IOFBs by to-and-fro movement of the teflon plunger in titanium handle[ 12 ].But this kind of forceps only can open up to 8–8.5 mm in the widest extent,which are limited in the extraction of large foreign bodies.Jenna Krivit et al described a nylon suture snare which is fashioned from a 23 or 25-gauge blunt tipped cannula, a 5−0 or 6−0 nylon suture, and a cotton tipped applicator[ 13 ]. The snare is introduced and extracted IOFB through a 23 or 25-gauge vitrectomy port.But the suture snare tying is time-consuming.And also,due to the short length of the vitrectomy port,the scleral incision needed to be extended with one-handed manipulation by the operating surgeon during IOFB extraction.This compromises the stability of the manipulation, makes it difficult to control the length of the scleral incision, and increases the risk of iatrogenic injury caused by the foreign body falling back onto the retina. YVONNE Y. Y. CHAN et al reported IOFB removal by using an intraocular snare constructed from modified flute needle.To construct the snare, one will need to remove the reservoir of 20-gauge flute needle ,and thread two ends of a 6−0 vicryl suture through the lumen of the flute needle then tied at the ends,and then replace the reservoir to the flute needle[ 8 ].This method is similar to the one we describe in this paper. However, knot preparation is relatively complicated, which prolongs the surgical duration.The present version of intraocular snare could be a simple and readily available alternative.Andrew W.Francis et al reported that successfully removed two 6-mm glass foreign bodies from the posterior segment of the eye by using a nitinol stone basket(NSB) which is designed for kidney stone extraction in the ureter and calyces[ 14 ].The NSB consists of a metal basket,an actuator handle,and a flexible polyimide tubing between them with a 120cm length.Although this instrument allows the extraction of relatively large IOFBs, it is associated with intricate maneuverability. Moreover, as the device is not specifically engineered for ophthalmic surgical procedures, the excessively long catheter may cause the rigid metal basket component to perforate the retina during foreign body manipulation, consequently leading to iatrogenic retinal injury. In addition, NBS is not readily accessible for clinical utilization. In conclusion,we decirbe a simple and elegant loop structure,which possess multiple advantages comparing with all the aforementioned devices. Its advantages are as follows: Economical and simple to construct from readily available consumables. Unlike forceps that are constrained by gripping force limitations, the knot can firmly secure IOFBs of varying sizes and properties. If initial IOFB extraction fails due to an undersized scleral incision, the assistant can hold the slipknot suture to fix the IOFB, allowing the primary surgeon to bimanually enlarge the incision or perform other maneuvers, thus preventing accidental retinal drop . Once the IOFB is ensnared and drawn to the scleral incision, the surgeon can adjust its orientation to align its smallest cross-section with the incision exit plane, minimizing the scleral incision size. We conclude that this loop formed by a slipknot device enables economical,convenient, and safe removal of IOFBs in all types. Abbreviations Intraocular foreign body(IOFB),pars plana vitrectomy (PPV),severe vision loss (SVL),best corrected visual acuity(BCVA),intraocular pressure (IOP),perfluorocarbon liquid(PFCL),perfluoropropane (C3F8) ,intraocular lens (IOL),nitinol stone basket(NSB). Declarations Ethics approval and consent to participate : In accordance with the Declaration of Helsinki,the patient provided written informed consent for publication of this case,including all clinical images and data.This study was approved by the the Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine.Ethics Committee No.2025-1453. Consent for publication: Written informed consent was obtained from the patient for publication of this case report. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding :Not applicable. Authors' contributions: YN G was responsible for drafting of the text,sourcing and editing of clinical images,investigation results. ZT S was responsible for critical revision for important intellectual content and giving final approval of the manuscript.All authors reviewed the manuscript and agreed with this submission. Acknowledgements: We are very grateful to the patient for being willing to share this educational case. References Chaudhry IA, Shamsi FA, Al-Harthi E, et al. Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol. 2008;246:181–6. Liu CC, Tong MK, Li PS, Li KK. Epidemiology and clinical outcome of intraocular foreign bodies in Hong Kong: a 13-year review. Int Ophthalmol. 2017;37:55–61. Loporchio D, Mukkamala L, ,Gorukanti K et al. Intraocular foreign bodies: A review[J].Survey of Ophthalmology,2016,61(5):582–96. 10.1016/j.survophthal.2016.03.005 Hoskin AK, Low R, Sen P, Mishra C, Kamalden TA, Woreta F, Shah M, Pauly M, Rousselot A, Sundar G, Natarajan S, Keay L, Gunasekeran DV, Watson SL, Agrawal R, IGATES Study Group - An Asia Pacific Ophthalmic Trauma Society publication. Epidemiology and outcomes of open globe injuries: the international globe and adnexal trauma epidemiology study (IGATES). Graefes Arch Clin Exp Ophthalmol. 2021;259(11):3485–3499. 10.1007/s00417-021-05266–1 . Epub 2021 Jun 26. Erratum in: Graefes Arch Clin Exp Ophthalmol. 2021;259(11):3521. doi: 10.1007/s00417-021-05408–5. PMID: 34173879. Li L, Lu H, Ma K, Li YY, Wang HY, Liu NP. Etiologic Causes and Epidemiological Characteristics of Patients with Intraocular Foreign Bodies: Retrospective Analysis of 1340 Cases over Ten Years. J Ophthalmol. 2018;2018:6309638. 10.1155/2018/6309638 . PMID: 29651344; PMCID: PMC5831630. Yuan M, Lu Q. Trends and Disparities in the Incidence of Intraocular Foreign Bodies1990–2019: A Global Analysis.Front. Public Health. 2022;10:858455. 10.3389/fpubh.2022.858455 . Widyanatha MI, Sungkono HS, Ihsan G, et al. Clinical findings and management of intraocular foreign bodies (IOFB) in third-world country eye hospital. BMC Ophthalmol. 2025;25:142. Chan YYY, Liu S, Tang GCH, Cheung JCC, Liu CCH, Li KKW. Removal of Intraocular Foreign Bodies Using a Modified Flute Needle. Retina. 2023;43(7):1209–1212. 10.1097/IAE.0000000000002964 . PMID: 37339140. Prabu B, Savithri P, ,Yeshwanth K et al. A NOVEL INTRAOCULAR FOREIGN BODY LOCKING FORCEPS[J].Retina,2025,45(5):1022–610.1097/IAE.0000000000004445 Assi A, Khoueir Z, A NEW AUTOMATED SNARE FOR THE REMOVAL OF INTRAOCULAR FOREIGN BODIES. Retina., Chen J, Li B. Y. A cross-knotted suture basket technique for large nonmagnetic intraocular foreign body removal. J Ophthalmol 2020;2020:1061462. Nur AA, NEW DESIGN INTRAOCULAR FOREIGN BODY. FORCEPS.[J].Retina (Philadelphia, Pa.),2017,37(12):2378–80. 10.1097/IAE.0000000000001839 Bapaye M, Shanmugam MP, Sundaram N. The claw: A novel intraocular foreign body removal forceps. Indian J Ophthalmol. 2018;66(12):1845–8. 10.4103/ijo.IJO_759_18 . PMID: 30451194; PMCID: PMC6256915. Krivit J, Giacalone JC, Andrade Romo J, Reiter GS, Ye RZ, Iezzi R. Nylon Suture Snare for Intraocular Foreign Body Removal: A Case Series. Retina. 2025;45(12):2424–2428. 10.1097/IAE.0000000000004608 . PMID: 40668961. Francis AW, Wu F, Zhu I, de Souza Pereira D, Bhisitkul RB. Glass intraocular foreign body removal with a nitinol stone basket. Am J Ophthalmol Case Rep. 2019;16:100541. 10.1016/j.ajoc.2019.100541 . PMID: 31517137; PMCID: PMC6732721. Additional Declarations No competing interests reported. Supplementary Files howtomakeaslipknot.mp4 File name:Additional file 1 Title of data :How to make a slipknot.MP4 Description of data :A movie file shows how to make a slipknot in more detail Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9352609","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":626522116,"identity":"9096bf8e-68ae-45b8-9603-7cd0750c4c33","order_by":0,"name":"Yi nan Gu","email":"","orcid":"","institution":"Zhoushan Hospital of Zhejiang Province","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"nan","lastName":"Gu","suffix":""},{"id":626522118,"identity":"e1971e02-d995-4c2b-8409-40d5e534979c","order_by":1,"name":"Zhitao Su","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYDACCcYGMM3G3nzgwAcDGztitDSC9fDzHEs8OKMgLZkILQwQayRn5Bgf5vlwCGopHiA/u7n9wY+KusQNNxIMDtsYHGBmYD98dAM+LYxzDjY29pw5nLjhzIOEwzkGd/gYeNLSbuDTwiyR2NjA23YgccPxhANALc+YGSR4zPBqYQNqafzbBnTYgcSGwxYGhxkbCGnhAWpp5m1jTpzZkcxwmIEYLRJALbNlzhw27uc5xnCwxyAtmY2QX+RnpD/4+KaiTraNvf/zhx9/bOz42Q8fw6sFi+9IUz4KRsEoGAWjABsAADxPVS5xoaYqAAAAAElFTkSuQmCC","orcid":"","institution":"The Second Affiliated Hospital, School of Medicine, Zhejiang University","correspondingAuthor":true,"prefix":"","firstName":"Zhitao","middleName":"","lastName":"Su","suffix":""}],"badges":[],"createdAt":"2026-04-08 06:40:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9352609/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9352609/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107451096,"identity":"7944244d-b85a-4466-af98-a780aa8693c3","added_by":"auto","created_at":"2026-04-21 15:16:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":585146,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExaminations before injury.\u003c/strong\u003eAn anterior segment photograph revealed a 4 o'clock direction corneal laceration approximately 4mm in length combined with lens opacity(A). Ultrasound confirmed the presence of a IOFB in the vitreous cavity(B).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9352609/v1/fc1610b83ce5cd176789f22c.png"},{"id":107451098,"identity":"d5b34770-91be-456d-a590-20921603fb5b","added_by":"auto","created_at":"2026-04-21 15:16:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1232324,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigs in operation.\u003c/strong\u003eThe initial location of IOFB(A). We used the PFCL to keep the IOFB away from the macula(B).Schematic diagram of the slipknot(C).The slipknot made in operation(D).The suture loop was delivered into the vitreous cavity via the pars plana incision(E).Placed the suture loop around the IOFB along its short axis (F).The IOFB was removing out with the assistance of endoillumination(G).The IOFB was completely extracted(H).\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9352609/v1/52a51429c49ff4fe0f6a1285.png"},{"id":107451099,"identity":"f39a35f9-c232-45af-9181-2117a328976d","added_by":"auto","created_at":"2026-04-21 15:16:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1173229,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExaminations after injury.\u003c/strong\u003e At the follow-up of 1 month,An anterior segment photograph revealed no anterior chamber inflammation(A).A scanning laser ophthalmoscopic image showed partial C3F8 bubbles in the vitreous cavity, and the retina was flat(B), with the macular retinal structure showing normal morphology(C).At the last follow-up,An anterior segment photograph revealed the well-centered IOL(D),and the well-attached retina(E). OCT imaging revealed no significant morphological abnormalities in the macula(F).\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-9352609/v1/ee2b9ebb065d5825102029e5.png"},{"id":107490507,"identity":"e1066875-acdf-4395-bfc7-c4454547aac7","added_by":"auto","created_at":"2026-04-22 02:53:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4740619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9352609/v1/2d2eaa02-5dc0-410d-a86c-cd33f6e39c7b.pdf"},{"id":107490353,"identity":"21260e5a-ce7b-45d2-97f1-dc00a3d8eb3f","added_by":"auto","created_at":"2026-04-22 02:51:52","extension":"mp4","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1837616,"visible":true,"origin":"","legend":"\u003cp\u003eFile name:Additional file 1\u003c/p\u003e\n\u003cp\u003eTitle of data :How to make a slipknot.MP4\u003c/p\u003e\n\u003cp\u003eDescription of data :A movie file shows how to make a slipknot in more detail\u003c/p\u003e","description":"","filename":"howtomakeaslipknot.mp4","url":"https://assets-eu.researchsquare.com/files/rs-9352609/v1/9d5d1b0d46ec5c6aa8e6fa03.mp4"}],"financialInterests":"No competing interests reported.","formattedTitle":"Large Glass Intraocular Foreign Body Removal with A Simple Slipknot:A Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eIt has been reported that 10% to 41% of open globe injuries are associated with intraocular foreign bodies (IOFBs), with the majority localized in the posterior segment[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e].This not only increases the risk of subsequent endophthalmitis and retinal detachment, which can determine severe vision loss (SVL)[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e], but also indicates that prompt foreign body removal is warranted.The prognosis largely depends on the size, nature, and location of the IOFBs[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEpidemiological studies indicate that IOFBs predominantly occur in young and middle-aged adults of working age, with most cases presenting good pre-injury visual acuity[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTherefore, the prognosis of traumatic eye injuries is crucial for such patients.Historically, IOFBs were removed by external magnet together with scleral cut-down[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. Currently, with the advancement of microsurgical techniques,surgical removal of IOFBs requires vitrectomy and extraction using a magnet or forceps[\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, such methods still face considerable difficulties in removing non-magnetic foreign bodies.Conventional forceps for IOFB removal have limited bite force, making them ineffective for large or irregularly shaped objects (e.g., glass). When the scleral incision for the IOFB is insufficient in length or the IOFB is too large for secure grasp, it may uncontrollably retract to the retina, causing iatrogenic retinal or even macular damage. Therefore, during IOFB procedures involving large or irregularly shaped objects, priority should be given to instruments and techniques that safely handle IOFBs of various sizes and properties, minimize surgical trauma, and are most readily available.\u003c/p\u003e\u003cp\u003eHearby,we describe a novel technique of a simple slipknot construction by using 8 − 0 polyglactin suture (Vicryl, Ethicon) to remove IOFBs effectively and safely.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 50-year-old female patient was referred to our hospital in June 2023 .The patient had suffered a glass explosion injury on her left eye,with blurred vision for 8 days after debridement and suturing.The general condition was normal.Negative for other ocular trauma or prior surgical history.On presentation,the best corrected visual acuity (BCVA) was 20/20 in the right eye and CF/30cm in the left eye. Intraocular pressure (IOP) was 11 mmHg in both eyes.No abnormalities were observed in the anterior or posterior segment of the right eye.The left eye presented a 4 o'clock direction corneal laceration approximately 4mm in length combined with local sutures,and also accompanied by lens opacity, which induce poor visualization of the vitreous body and fundus(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eA).Ultrasound and orbital CT confirmed the presence of a IOFB in the vitreous cavity(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003eB)(Unfortunately,the orbital CT was performed at the local hospital, and the images were not retained).The IOFB was approximately 15mm in length and 4 mm in width.In the setting of IOFB removal, a standard 3-port PPV was performed. After core-vitrectomy, the vitreous around the IOFB was partially removed to allow access of the suture loop to the IOFB.Perfluorocarbon liquid (PFCL) was used to keep the IOFB away from the macula (Figure. 2A,B), followed by resection of the peripheral vitreous.Then, a pre-constructed slipknot was prepared externally with 8−0 Vicryl suture to construct a loop structure(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eC,D,also an additional movie file shows how to make a slipknot in more detail [see Additional file 1]).The suture loop was delivered into the vitreous cavity via the pars plana incision at the 10 o'clock position using micro intraocular forceps, and then placed the suture loop around the IOFB along its short axis with the assistance of endoillumination.One end of the slipknot was tightened by the assistant surgeon to secure the IOFB firmly(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eE,F).Subsequently, the residual vitreous around the IOFB was removed with the vitrectomy cutter, and the IOFB was completely extracted via the scleral incision(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eG,H).Finally, laser photocoagulation was performed on the retinal injured and degenerative areas, and the vitreous cavity was tamponaded with perfluoropropane (C3F8) gas.Postoperatively, the patient received anti-inflammatory and symptomatic treatment,and was followed up 1 day, 4 days, 1 month, 3 months after the surgery.At the follow-up of 1 month after the surgery, the BCVA of left eye was 20/63.No intraocular inflammatory reaction was observed and the retina was flat with the macular retinal structure showing normal morphology(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA-C).At the follow-up of 3 months after the surgery, the BCVA of left eye was 20/40.We then performed scleral intralamellar fixation of the intraocular lens (IOL).At the last follow-up,the BCVA of left eye had improved to BCVA 20/32,with well-centered IOL, well-attached retina and absence of proliferative vitreoretinopathy(PVR). OCT imaging revealed no significant morphological abnormalities in the macula.(Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eD-F).\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eRecent advances in surgical techniques and instrumentation have significantly improved the\u003c/p\u003e\u003cp\u003emanagement and removal of IOFBs. A variety of forceps, snares,\u003c/p\u003e\u003cp\u003ebaskets, and magnets have been developed,but the extraction of large, sharp, or irregular ones remains challenging for surgeons[10,10a].Nur Acar described an ACAR foreign body forceps,which were produced in Turkey[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].The advantage of this foreign body forceps lies in its ease of extracting spherical IOFBs,but they need to be purchased beforehand.ManeeshBapaye et al reported a claw-shaped forceps,which can remove IOFBs by to-and-fro movement of the teflon plunger in titanium handle[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e].But this kind of forceps only can open up to 8–8.5 mm in the widest extent,which are limited in the extraction of large foreign bodies.Jenna Krivit et al described a nylon suture snare which is fashioned from a 23 or 25-gauge blunt tipped cannula, a 5−0 or 6−0 nylon suture, and a cotton tipped applicator[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The snare is introduced and extracted IOFB through a 23 or 25-gauge vitrectomy port.But the suture snare tying is time-consuming.And also,due to the short length of the vitrectomy port,the scleral incision needed to be extended with one-handed manipulation by the operating surgeon during IOFB extraction.This compromises the stability of the manipulation, makes it difficult to control the length of the scleral incision, and increases the risk of iatrogenic injury caused by the foreign body falling back onto the retina.\u003c/p\u003e\u003cp\u003eYVONNE Y. Y. CHAN et al reported IOFB removal by using an intraocular snare constructed from modified flute needle.To construct the snare, one will need to remove the reservoir of 20-gauge flute needle ,and thread two ends of a 6−0 vicryl suture through the lumen of the flute needle then tied at the ends,and then replace the reservoir to the flute needle[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e].This method is similar to the one we describe in this paper. However, knot preparation is relatively complicated, which prolongs the surgical duration.The present version of intraocular snare could be a simple and readily available alternative.Andrew W.Francis et al reported that successfully removed two 6-mm glass foreign bodies from the posterior segment of the eye by using a nitinol stone basket(NSB) which is designed for kidney stone extraction in the ureter and calyces[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e].The NSB consists of a metal basket,an actuator handle,and a flexible polyimide tubing between them with a 120cm length.Although this instrument allows the extraction of relatively large IOFBs, it is associated with intricate maneuverability. Moreover, as the device is not specifically engineered for ophthalmic surgical procedures, the excessively long catheter may cause the rigid metal basket component to perforate the retina during foreign body manipulation, consequently leading to iatrogenic retinal injury. In addition, NBS is not readily accessible for clinical utilization.\u003c/p\u003e\u003cp\u003eIn conclusion,we decirbe a simple and elegant loop structure,which possess multiple advantages comparing with all the aforementioned devices.\u003c/p\u003e\u003cp\u003eIts advantages are as follows:\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEconomical and simple to construct from readily available consumables.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUnlike forceps that are constrained by gripping force limitations, the knot can firmly secure IOFBs of varying sizes and properties.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIf initial IOFB extraction fails due to an undersized scleral incision, the assistant can hold the slipknot suture to fix the IOFB, allowing the primary surgeon to bimanually enlarge the incision or perform other maneuvers, thus preventing accidental retinal drop .\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOnce the IOFB is ensnared and drawn to the scleral incision, the surgeon can adjust its orientation to align its smallest cross-section with the incision exit plane, minimizing the scleral incision size. We conclude that this loop formed by a slipknot device enables economical,convenient, and safe removal of IOFBs in all types.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIntraocular foreign body(IOFB),pars plana vitrectomy (PPV),severe vision loss (SVL),best corrected visual acuity(BCVA),intraocular pressure (IOP),perfluorocarbon liquid(PFCL),perfluoropropane (C3F8) ,intraocular lens (IOL),nitinol stone basket(NSB).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate : In accordance with the Declaration of Helsinki,the patient provided written informed consent for publication of this case,including all clinical images and data.This study was approved by the the Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine.Ethics Committee No.2025-1453.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Written informed consent was obtained from the patient for publication of this case report.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding :Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: YN G was responsible for drafting of the text,sourcing and editing of clinical images,investigation results. ZT S was responsible for critical revision for important intellectual content and giving final approval of the manuscript.All authors reviewed the manuscript and agreed with this submission.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: We are very grateful to the patient for being willing to share this educational case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChaudhry IA, Shamsi FA, Al-Harthi E, et al. Incidence and visual outcome of endophthalmitis associated with intraocular foreign bodies. Graefes Arch Clin Exp Ophthalmol. 2008;246:181\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu CC, Tong MK, Li PS, Li KK. Epidemiology and clinical outcome of intraocular foreign bodies in Hong Kong: a 13-year review. Int Ophthalmol. 2017;37:55\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoporchio D, Mukkamala L, ,Gorukanti K et al. 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BMC Ophthalmol. 2025;25:142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan YYY, Liu S, Tang GCH, Cheung JCC, Liu CCH, Li KKW. Removal of Intraocular Foreign Bodies Using a Modified Flute Needle. Retina. 2023;43(7):1209\u0026ndash;1212. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IAE.0000000000002964\u003c/span\u003e\u003cspan address=\"10.1097/IAE.0000000000002964\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 37339140.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrabu B, Savithri P, ,Yeshwanth K et al. A NOVEL INTRAOCULAR FOREIGN BODY LOCKING FORCEPS[J].Retina,2025,45(5):1022\u0026ndash;610.1097/IAE.0000000000004445\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssi A, Khoueir Z, A NEW AUTOMATED SNARE FOR THE REMOVAL OF INTRAOCULAR FOREIGN BODIES. Retina., Chen J, Li B. Y. A cross-knotted suture basket technique for large nonmagnetic intraocular foreign body removal. J Ophthalmol 2020;2020:1061462.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNur AA, NEW DESIGN INTRAOCULAR FOREIGN BODY. FORCEPS.[J].Retina (Philadelphia, Pa.),2017,37(12):2378\u0026ndash;80.\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IAE.0000000000001839\u003c/span\u003e\u003cspan address=\"10.1097/IAE.0000000000001839\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBapaye M, Shanmugam MP, Sundaram N. The claw: A novel intraocular foreign body removal forceps. Indian J Ophthalmol. 2018;66(12):1845\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijo.IJO_759_18\u003c/span\u003e\u003cspan address=\"10.4103/ijo.IJO_759_18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 30451194; PMCID: PMC6256915.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrivit J, Giacalone JC, Andrade Romo J, Reiter GS, Ye RZ, Iezzi R. Nylon Suture Snare for Intraocular Foreign Body Removal: A Case Series. Retina. 2025;45(12):2424\u0026ndash;2428. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/IAE.0000000000004608\u003c/span\u003e\u003cspan address=\"10.1097/IAE.0000000000004608\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 40668961.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancis AW, Wu F, Zhu I, de Souza Pereira D, Bhisitkul RB. Glass intraocular foreign body removal with a nitinol stone basket. Am J Ophthalmol Case Rep. 2019;16:100541. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajoc.2019.100541\u003c/span\u003e\u003cspan address=\"10.1016/j.ajoc.2019.100541\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 31517137; PMCID: PMC6732721.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intraocular foreign body, Open globe injury, Slipknot, Suture","lastPublishedDoi":"10.21203/rs.3.rs-9352609/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9352609/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOpen globe injuries with intraocular foreign bodies(IOFBs)are characterized by complexity and diversity.The removal of IOFBs poses a unique challenge to ophthalmic surgeons.Particularly for large or irregular non-magnetic IOFBs in the posterior pole, considerable difficulty exists.We report a novel technique of a simple slipknot construction by using 8\u0026thinsp;\u0026minus;\u0026thinsp;0 polyglactin suture (Vicryl, Ethicon) to remove IOFBs effectively and safely.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA 50-year-old healthy female sustained a left eye glass explosion injury while working without wearing goggles 8 days ago. Despite debridement and suturing, the patient still experienced blurred vision and was subsequently referred to the our ophthalmology department .An IOFB in vitreum was indicated by B-ultrasound and orbital CT,which was approximately 15mm in length and 4 mm in width, with a glass-like nature.We performed pars plana vitrectomy (PPV) combined with IOFB removal by utilizing a simple slipknot made with 8\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl suture in the left eye for the patient, with no complications observed.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis kind of slipknot enables safe and rapid removal of IOFBs, featuring economical and simple to construct from readily available consumables,which make it particularly suitable for large and irregular IOFBs.The tight ligation effectively prevents accidental detachment of the IOFBs, thereby avoiding iatrogenic retinal injury.\u003c/p\u003e","manuscriptTitle":"Large Glass Intraocular Foreign Body Removal with A Simple Slipknot:A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-21 15:16:19","doi":"10.21203/rs.3.rs-9352609/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b993954-5306-4712-bc6f-027abf9b9b94","owner":[],"postedDate":"April 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-21T15:16:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-21 15:16:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9352609","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9352609","identity":"rs-9352609","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}