The DoD Joint Pathology Center (JPC)/ Vision Center of Excellence (VCE) ocular foreign body compositional analysis program

Abstract

Purpose : The composition of intraocular and periocular foreign bodies (FBs) can affect visual outcome, particularly in regards to metallosis, reactivity, or infection. Yet the ability to provide such analysis is limited—because of their small size, many are lost in handling and transit, or lost or destroyed in pathologic preparation. Additionally, fragile intraocular FBs may be destroyed in the process of vitrectomy and removal. Moreover, analysis is typically limited to gross descriptions such as “Metal, non-magnetic, may be copper”. This severely limits overall knowledge of ocular injuries as well as impacting clinical treatments. In response, in 2014 the DoD established a centralized program for sophisticated compositional analysis of such foreign bodies. The program is available to all DoD and VA facilities. Analytic evaluation includes radioactivity screen, radiography, assessment of physical properties, gross photography, stereo-microscopy, scanning electron microscopy (SEM) with energy dispersive x-ray spectroscopy (EDS), and Fourier transform infrared micro-spectroscopy (FT-IR). Larger metallic fragments are also examined with energy dispersive x-ray fluorescence (EDXRF), an elemental surface analytical technique routinely used for larger fragments. These non-destructive methods provide information on the surface elemental and molecular composition of periocular and intraocular foreign bodies. We review submissions and progress since inception of the program

Methods : Retrospective review of intraocular and periocular specimens submitted to the JPC for compositional analysis from 2014-2017

Results : Since 2014, 13 specimens from 12 patients were received from 7 facilities (6 DoD, 1 VA); 10 intraocular, 3 conjunctival and periocular. Specimens included 9 metallic and 4 non-metallic foreign bodies. Most specific metallic compositions were multi-elemental with a predominance of iron (5), copper (2), lead (1), and aluminum (1). Non-metallic compositions included plastic (1), glass (1), carbon (1), silca and silica substrates (1), and nitrate/nitrocellulose (1)

Conclusions : The JPC ocular foreign body analysis program provides a centralized opportunity for sophisticated compositional analysis for DoD and VA ophthalmologists. The program supports clinical decision-making and provides valuable clinical, epidemiological, and research information following ocular injury

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.