First Author: M.A.Sekeroglu TURKEY
Co Author(s): H. Tirhis F. Koc P. Yilmazbas 0 0 0 0 0 0 0 0 0
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To discuss the complications and management of inadvertently injected intralenticular sustained-release dexamethasone implant in a patient with persistent macular edema secondary to branch retinal vein occlusion
Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
We present a 53-year-old man with right macular edema secondary to branch retinal vein occlusion. The implant was injected via the pars plana route 3.5 mm from the limbus, but accidentally injected into the crystalline lens because of an involuntary head movement during the procedure.
Optical coherence tomography (OCT) of the right eye revealed macular edema and a central macular thickness (CMT) of 525 µm initially with a best corrected visual acuity (BCVA) of 48 letters. CMT and BCVA were 253 µm-58 letters at first month, 262 µm-56 letters at third month and 254 µm-48 letters at sixth month. Macular edema subsided within time while BCVA did not show significant improvement due to increase in lens opacification. Intraocular pressure (IOP) was between 13-16 mmHg during follow-up. The patient underwent phacoemulsification surgery with implantation of posterior chamber intraocular lens into capsular bag. After the cataract surgery, the patient had a BCVA of 63 letters with a normal IOP and a normal foveal contour on OCT. The fellow eye was completely normal.
Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but probable complication that is mostly caused by uncontrolled head movement during procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy. However, remarkable decrease in macular edema and visual acuity improvement can also be achieved without an immediate surgical intervention. Postponement of the lens extraction and removal of the implant until the completion of the effect may prevent unnecessary re-injections. Additionally, fibrosis of the posterior lens capsular defect can enable an uneventful cataract surgery with intraocular in the bag lens implantation. This rare condition should be borne in mind during intravitreal injections.