Removal of Steel from the Vitreous 
BY THE 
ELECTRO-MAGNET. 
By E. E. HOLT, M. D., 
PORTLAND, ME. 
.Member of the American Ophthalmological and Otologic ai. Societies. 
Executive and Senior Attending Surgeon of the Maine Eve and Ear Infirmary. 
[Reprinted from American Ophthalmological Society Tran, [Reprinted from American Ophthabnological Society Transactions, 1893.] 
REMOVAL OF STEEL FROM THE VITREOUS BY THE 
ELECTRO-MAGNET. 
By E. E. IIOLJ, M. D., 
PORTLAND, ME. 
Member of the American Ophthalmological and Otological Societies. 
Executive and Senior attending Surgeon of the Maine Eye and Ear Infirmary. 
An eye that has sustained an injury by the penetration of a foreign 
body into its interior presents an interesting problem for the surgeon 
who is consulted to consider. The surgeon’s responsibility is the same 
whether sight is immediately affected or a wound has been produced 
that tends to that end and sympathetic inflammation. He must decide 
from his own experience, or that of others, what shall be his treatment 
of each individual case, and, as there seems to be a difference of opinion 
as to the best method to pursue in such cases, it is certainly our duty 
as members of this Society to report our experience. With this end in 
view, the three following cases, which have occurred in my private 
practice during the past year, are added to the six reported by me to 
this Society in 1891 : 
Case 1. 0. A. W. (8689), aged 34, while chiseling out a set-screw, 
a piece of steel struck his right eye about ten hours before he presented 
himself at my office. Examination showed a wound in the cornea, near 
the junction of the middle and lower third of its vertical diameter, of 
about two millimeters in diameter. There was a notch in the iris of 
about the size of the wound in the cornea, and the missile had passed 
obliquely through the lens, fracturing it in such a manner that no view 
of the interior of the eye could be obtained. The seriousness of the 
wound to the eye was stated to the patient. The possibility of the 
steel becoming encapsulated or setting up sympathetic inflammation, 
and finally, the chance of removing it by the electro-magnet, was made 
as clear as possible to him. He decided to have it removed by the 
electro-magnet, with the understanding that if the attempt was not 
successful the eye would be removed before he recovered from the 
influence of the ether. With the assistance of Dr. Bowers and Mr. 
Clough he was placed under the influence of ether. The conjunctiva 
was dissected off between the external and inferior recti muscles back 
to the equator of the eyeball, and an incision eight or ten millimeters 
long was made near the equator of the eyeball horizontal to its antero- 
posterior diameter. As the knife passed into the vitreous it came in Holt : Removal of Steel from the Vitreous. 
contact with the steel, and its easy removal was anticipated. There 
was not much hemorrhage and no escape of vitreous. The long straight 
point of Bradford’s magnet was introduced, but no steel was touched or 
came out on its point. This was repeated for the fifth time before the 
steel was secured. It was one and a half millimeters long, and its 
width and thickness were less than a millimeter. The sclerotic wound 
was cleaned and approximated and the external conjunctival wound 
was united by one suture. Both eyes were covered with cotton, which 
was held in place with silk isinglass plaster. The patient was advised 
to rest in the recumbent position as enjoined upon persons after cataract 
operations. There was no pain, and the patient made an uninterrupted 
recovery. The lens became absorbed, and with a cataract glass he had 
good vision. The field of vision was good and he was enabled to esti- 
mate distances correctly with the other eye. This enabled him to 
resume his occupation, which was that of machinist. This accident 
occurred the first part of last August, nearly a year ago, and he has 
had no trouble since he began work. 
Case ‘2. W. K., aged 23 (9571). While placing a block upon the 
platform around a circular saw revolving twelve hundred revolutions a 
minute, the hook by which he held the block struck the saw and a piece 
of the steel flew and struck his left eye. There was a wound in the 
upper nasal quadrant of the cornea midway between its vertical and 
horizontal diameters, its upper end just crossing the sclero-corneal 
margin. A corresponding opening existed in the iris, and the missile 
had passed obliquely through the lens, fracturing it so that no view of 
the fundus could be obtained. The case was stated to him and his 
friends as in case No. 1. They elected to have the steel removed by 
the electro-magnet if possible. Failing in that, it was understood that 
the eye should be removed. He was placed under the influence of 
ether with the assistance of Mr. Clough. The conjunctiva was dissected 
off between the external and inferior recti back to the equator of the 
eyeball. An incision was made in the sclerotic near the equator, below 
its horizontal diameter and obliquely to it. As the Graefe knife passed 
into the vitreous it came in contact with the steel. Upon withdraw- 
ing it and inserting the long straight point of Bradford’s magnet the 
steel was found on its end when it was withdrawn. The sclerotic wound 
was cleaned and the external wound was united with one suture. The 
eyes were dressed and the patient put to bed, as described in the pre- Removal of Steel from the Vitreous 
3 
Holt : 
vious case. There was no interruption in the recovery of the case until 
the seventh day, when he began to have severe pain in the eye, which 
was no doubt due to swelling of the lens. This pain continued, more 
or less severe, for about a week, in spite of active treatment for its 
relief. The lens became more or less absorbed, and the field of vision 
thus obtained was useful in his ability to estimate distances, and enabled 
him to return to his work. 
Case 3. H. W., aged 16 (9806). Two days since, while driving 
down an iron hoop on a pork barrel with a cold-chisel, he felt something 
strike his right eye. On examination of the eye there was a wound in 
the cornea about three millimeters long, crossing its horizontal diameter 
on the nasal side near the sclerol-corneal margin. There was a hori- 
zontal quadrangular opening in the iris opposite the wound in the cornea, 
which at first glance looked like a foreign body on the iris. The steel 
passed through the edge of the lens, but its center remained clear so 
that the optic disc could be seen. Search was made with the ophthal- 
moscope for the foreign body, but it could not be located on account of 
the opacities of the media due to the injury. There was a small amount 
of pus in the anterior chamber, and after stating the case to him as 
clearly as possible and advising him that the easiest way out of the 
accident was to have the eye removed, he still insisted upon having the 
steel removed by the electro-magnet, but consented to have the eye 
removed after it should be found that the steel could not be removed 
by the electro-magnet. He was placed under the influence of ether by 
the assistance of Mr. Clough. After dissecting down between the 
external and inferior recti muscles a small incision was made near the 
equator of the eye. As the Graefe knife passed into the vitreous it 
came in contact with the steel. Passing in the long straight point of 
Bradford’s magnet I was gratified to find the steel upon its point upon 
withdrawing it the first time. The sclerotic wound was cleaned and the 
conjunctival wound united with one catgut suture. The next morning 
the hypopyon had disappeared, and at the end of a week the eye was 
clear. This was, on account of the suppurative inflammation present, 
the most unpromising one of this series, but it made the most rapid 
recovery, without pain and with good vision, equal to two tenths. 
Since these three cases were reported I have operated upon two 
more similar cases successfully. 
Portland, Maine, January, 1894. Case I