Accidental Intralenticular Injection of Ozurdex® for Branch Retinal Vein Occlusion: Intact Posterior Capsule and Resolution of Macular Edema

Abstract

Purpose. We present a case of accidental intralenticular injection of Ozurdex implant in a patient with macular edema secondary to branch retinal vein occlusion. Method. A case report. Results. Intravitreal dexamethasone implant injection had been performed for macular edema due to left superior temporal vein branch occlusion to the left eye of a 78-year-old male patient. The slit-lamp examination 85 days later revealed that the dexamethasone implant was intralenticular. The best-corrected visual acuity (BCVA) was 0.16 on the Snellen chart. Cataract surgery was decided on for the cataract as there was no anterior chamber inflammation, the intraocular pressure (IOP) was normal, and the macular edema had resolved. Uneventful phacoemulsification within the bag intraocular lens placement was performed. Conclusions. Accidental intralenticular Ozurdex injection is an extremely rare complication. The surgeon must decide whether to continue to observe or intervene immediately when such a complication is encountered. Cataract surgery can be planned if the macular edema has resolved and a cataract has developed. It is important to evaluate the posterior capsule with ultrasound biomicroscopy and Scheimpflug imaging before the cataract surgery to ensure a safe surgical procedure.

Case of Reposition of Intralenticular Dexamethasone Implant into the Berger’s Space

“…Occasionally, it is possible to leave Ozurdex in the crystalline lens intact [8]. In some cases, if the posterior capsule is undamaged, it is possible to leave Ozurdex intralenticular intact, and remove it within a period of 85 days after injection [5]. In our opinion, there is a need to perform phacoemulsification as soon as possible.…”

“…However, repositioning of the implant into Berger's space resulted in a favorable therapeutic effect with a good anti-inflammatory and anti-edema response. Some authors have described the efficacy of Ozurdex even in cases with its intralenticular position [5].…”

Intralenticular Ozurdex injection in an eye with thicker lens and the therapeutic effect maintained for 15 months

“…The results showed that the right eye (without Ozurdex injection) had persistent uveitis and the left eye (with Ozurdex injection) had no uveitis, indicating that intralenticular Ozurdex was still effective for uveitis and the effect duration of intralenticular Ozurdex was much longer than normal (4–6 months). A previous study indicated that, after the discovery of intralenticular injection of Ozurdex, immediate cataract surgery might increase the posterior capsule stress and tear the posterior capsule [ 23 ]. When we chose the wait-and-see strategy, the posterior capsule rupture might become fibrosed and recover during the follow-up period.…”

Accidental intralenticular sustained-release dexamethasone (Ozurdex) implantation: A case report

“…The development of cataract may take as long as 10-12 months after injection [2,3,13]. Some authors [2,3,5,14,15] have found resolution of the macular edema with an intralenticular implant. Coca-Robinot et al [12] and Baskan et al [4] found no significant macular edema improvement.…”