Intravitreal dexamethasone implant in the crystalline lens

Abstract

We report the case of a 58-year-old man who developed macular edema due to superior temporal vein occlusion in his right eye. A dexamethasone implant was inadvertently injected into the crystalline lens. Slitlamp examination revealed the position of the implant. The intralenticular dexamethasone implant was clearly imaged in front of the posterior lens capsule by highfrequency ultrasound biomicroscopy. The patient was followed without repositioning of the dexamethasone implant. During the 6-month follow-up, no additional side effect was observed, the macular edema decreased, and the vision improved.Financial Disclosure: Neither author has a financial or proprietary interest in any material or method mentioned. JCRS Online Case Reports 2014; 2:e12-e15 Q 2014 ASCRS and ESCRSRetinal vein occlusion is considered the second most common retinal vascular disorder after diabetic retinopathy. 1 Cystoid macular edema (CME) is a common sight-threatening complication of retinal vein occlusion. 2 Multiple treatment strategies have been attempted for the treatment of macular edema, including laser photocoagulation, antivascular endothelial growth factor, and corticosteroid injections. 3 The dexamethasone intravitreal implant (Ozurdex), a biodegradable implant of dexamethasone (0.7 mg) used as injection into the vitreous cavity, has recently become a valuable treatment option for eyes with visual impairment due to macular edema related to central retinal vein occlusion and branch retinal vein occlusion. This rod-shaped implant is 6.0 mm in length and 0.46 mm in diameter. The implant dissolves in the vitreous while slowly releasing the dexamethasone for up to 6 months. It has been approved by U.S. Food and Drug Administration for the treatment of macular edema secondary to retinal vein occlusion and noninfectious uveitis affecting the posterior segment. 4,5 As a consequence of increased popularity of intravitreal injections, many complications such as intraocular pressure (IOP) elevation, cataract formation, endophthalmitis, intraocular hemorrhage, hypotony, and retinal detachment have been reported. 6,7 We report an inadvertent injection of a dexamethasone implant into the crystalline lens. To our knowledge, this is the first report of a patient with an inadvertent dexamethasone implant without repositioning in the absence of side effects. CASE REPORTA 58-year-old man presented with a 3-day history of decreased vision in his right eye. The corrected distance visual acuity (CDVA) was 1.0 logMAR (decimal equivalent of 0.1) in the right eye and 0 logMAR (decimal equivalent of 1.0) in the left eye. Intraocular pressure was 17 mm Hg and 16 mm Hg, respectively. Anterior segment examination revealed early nuclear cataract in both eyes. Fundus examination showed macular edema and retinal hemorrhages in the superior retina of the right eye (Figure 1, A). Optical coherence tomography (OCT) revealed CME with a central macular thickness of 579 mm (Figure 1, B). Clinical findings and investigations confirmed superior branch retinal vein occ...

Inadvertent intralenticular dexamethasone implant: 1-year follow-up and management

“…There are six case reports in the literature related to this topic. [ 2 3 4 5 6 7 ] There are several reasons for injecting into the lens. Regarding the intravitreal procedure: The 22-gauge injector has a relatively large diameter compared to 28- or 30-gauge needles used for antivascular endothelial growth factor (VEGF) treatment, and the injection technique requires excess pressure on the globe.…”

“…In addition, if the applicator needle is not perpendicular to the vitreous cavity, the needle may be advanced into the lens, and the dexamethasone implant may be injected into the crystalline lens. [ 3 ]…”