First Author: J.Gutiérrez Vásquez SPAIN
Co Author(s): J. Obis Alfaro A. Rodriguez-Marco M. Cipres Alastuey A. Gavin Sancho S. Fernandez Larripa
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To report three cases and follow-up of intraocular complications after intravitreal injection, implant of dexametasone and periocular anaesthesia.
Miguel Servet University Hospital, Zaragoza, Spain
Case 1: A 67 year old female came with the history of 5 days of blur vision on left eye after intravitreal injection. She was being treated for proliferative diabetic retinopathy. Visual acuity was 20/400 on left eye. In biomicroscopy a posterior linear tract crossing the visual axis with an ending bubble at the nasal pole was found inside posterior lens. Case 2: A 46 year old male came to schedule revision one month after intravitreal dexametasone implant on left eye. He was being treated for cystoid macular edema in the context of diabetic retinopathy. He referred no new symptons during visit. Visual acuity was 20/200. In biomicroscopy, a large white cilinder was found between iris and intraocular lens without crossing visual axis. Intraocular pressure was 20 mmHg. No signs of inflamation were found. Case 3: A 20 year old male came with the history of 1 month of central blur vision in left eye. He was treated for a maxillary cyst 1 year earlier. Visual acuity was hands movement. Biomicroscopy was anodine. Eye fundus revealed a linear tract in temporal zone without retina detachment. Optical coherence tomography (OCT) found full absence of photorreceptor layer without subrretinal fluid.
Case 1: A phacoemulsification with anterior vitrectomy was performed 1 month later. Despite the time of the intervention, a soft cataract was found with minimal changes from last visit. Visual acuity after surgical intervention was still 20/400 mainly because of retinal damage of her diabetic retinopathy. Case 2: One month follow-up schedule were performed for 6 months, During visits, intraocular pressure was stable, iris anatomy remained stable and no inflamation on posterior or anterior pole was found. Vision improved from 20/200 to 6/20 while implant was active. Last visit revealed a full reabsortion of the implant. Case 3: Due to the nature of the lesion, estimated posibilities for recovery were none during evaluation. Despite the time of maxillary cyst procedure, and tract following the same route of local anaesthesia, we assumed this as a periocular anaesthesia complication. No treatment was administered. A follow-up 6 months later revealed no changes on initial evaluation.
Caution must be taken on every procedure. Despite of the safety of all mentioned techniques, sometimes overconfidence, lack of colaboration of the patient among others may convert a normal procedure into nightmares.