First Author: R.Falah SPAIN
Co Author(s): I. Alarcon Valero S. Khaouly Alonso N. Najjari Jamal A. Martinez Palmer
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To report a case of uncommon iatrogenic dexamethasone intravitreal implant injection into the crystalline lens and its management
Esperanza Hospital. Parc de Salut Mar: Department of ophthalmology. Section of vitreo retinal surgery. Barcelona, Spain.
We present the video of the surgical management in the case of a 62-year-old man with diabetic macular edema, who underwent intravitreal injection of dexamethasone implant. During the procedure, the implant was accidentally injected into the lens body. Slit lamp examination showed the implant completely located inside the crystalline lens with a circumscribed area of cataract formation around the point of penetration in the posterior capsular of the lens. Intraocular pressure was 18mmHG at 24hours control and the patient remained asymptomatic, because the implant didn´t affect the visual axis in addition to a very poor initial visual acuity.
The patient was scheduled for phacoemulsification surgery of the lens with implantation of a 3-piece lens into the sulcus. Surgery was performed 5 days after the dexamethasone accidental lens implantation. First the cataract was removed and then the dexamethasone implant was repositioned to the posterior segment through its entrance tear in the posterior capsule. Anterior and posterior vitrectomy were performed and then a 3-piece lens was implanted into the sulcus.
Few problems involving the anterior segment in dexamethasone implants have been described. Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but possible complication that can occur in 0.009% of cases This complication is mostly caused by surgeon inexperience, improper technique and uncontrolled head movement during the procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy keeping in mind the possible damage of the structures such as posterior capsule or lens zonules.