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Konyagoz Hospital, Department of Ophthalmology, Konya, Türkiye DOI : 10.37845/ret.vit.2024.33.34 In this report, we wanted to present a case showing how surgical difficulties were managed in the removal of a metallic intraocular foreign body accompanied by posterior pole perforation. A 43-year-old male patient sustained an accidental penetrating injury to his left eye while working. Biomicroscopic examination revealed a foreign body entry site and iris prolapse at the corneascleral junction in the inferotemporal quadrant, while fundus examination revealed a vitreous hemorrhage covering the optic disc and macula. Computed tomography showed an intraocular foreign body perforating the posterior pole between the optic disc and the macula and localizing between the globe and the retrobulbar area. A retrobulbar injection involving epinephrine was administered to the patient under general anesthesia at the beginning of the surgery to reduce intraoperative bleeding and prevent the intraocular foreign body from escaping into the retrobulbar space. Following the closure of the primary wound with 10.0 nylon, a standard three-port-25-gauge pars plana vitrectomy was performed and the intraocular foreign body was captured by advancing through the posterior pole defect with ERM forceps. The 6*5 mm sharp-edged intraocular metallic foreign body was removed through a 6 mm pars plana incision. The procedure was terminated by injecting silicone oil into the vitreous cavity. At the last visit 8 months after surgery, best-corrected visual acuity was 20/80. In the management of intraocular metallic foreign body injuries perforating the posterior pole, preoperative retrobulbar injection of an anesthetic agent involving epinephrine can be very useful in removing the foreign body and ensuring intraoperative hemostasis. Keywords : Intraocular foreign body, pars plana vitrectomy, posterior pole perforation, open globe injury