|Year : 2023 | Volume
| Issue : 1 | Page : 196-197
Surgical repositioning of iatrogenic intralenticular steroid implant
Amit S Nene1, Madhuri Meshram1, Aniruddha S Nibhorkar2, Pratik Shenoy1, Pushpanjali Badole1, Smitesh Shah2, Onkar H Pirdankar3
1 Department of Vitreo-Retina, Isha Netralaya, Maharashtra, India
2 Department of Cataract, Isha Netralaya, Maharashtra, India
3 Department of Optometry, Isha Netralaya, Maharashtra, India
|Date of Submission||12-Aug-2022|
|Date of Acceptance||23-Sep-2022|
|Date of Web Publication||20-Jan-2023|
Onkar H Pirdankar
Isha Netralaya, Karnik Road, Kalyan West, Maharashtra
Source of Support: None, Conflict of Interest: None
Keywords: Complication, macular edema, Ozurdex implant
|How to cite this article:|
Nene AS, Meshram M, Nibhorkar AS, Shenoy P, Badole P, Shah S, Pirdankar OH. Surgical repositioning of iatrogenic intralenticular steroid implant. Indian J Ophthalmol Case Rep 2023;3:196-7
|How to cite this URL:|
Nene AS, Meshram M, Nibhorkar AS, Shenoy P, Badole P, Shah S, Pirdankar OH. Surgical repositioning of iatrogenic intralenticular steroid implant. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:196-7. Available from: https://www.ijoreports.in/text.asp?2023/3/1/196/368203
We report a case of an accidental intralenticular Ozurdex implant (dexamethasone intravitreal implant) and its management. A 55-year-old male was diagnosed with proliferative diabetic retinopathy (PDR) with chronic macular edema (CME) in the right eye following multiple anti–vascular endothelial growth factor (anti-VEGF) injections [Figure 1] and had a best-corrected visual acuity (BCVA) of 6/60. The other eye had stable PDR with BCVA of 6/9. The patient underwent Ozurdex (DEX Implant; Allergan, Inc., Irvine, CA, USA) implantation under topical anesthesia in the right eye. At one-week follow-up, anterior segment examination showed nuclear sclerosis grade 1 with posterior subcapsular cataract and the Ozurdex implant was seen breaching the posterior capsule of the lens inferonasally [Figure 2]. His BCVA in the right eye was 6/60 with normal intraocular pressure. The patient underwent uneventful cataract surgery [Figure 3] and the implant was pushed behind with a Sinskey hook into the vitreous cavity through posterior capsular breach. A three-piece foldable intraocular lens (IOL) was placed in the capsular bag. At one-month follow-up, BCVA improved to 6/18. The implant was well repositioned behind the IOL in the vitreous cavity and optical coherence tomography (OCT) revealed significant reduction in macular edema [Figure 4].
|Figure 3: Management of intralenticular Ozurdex implant (a). Phacoemulsification (b). Pushing the implant through posterior capsular breach (c). Repositioning of the implant (d). After IOL implantation|
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|Figure 4: Slit-lamp anterior segment photo and OCT of the right eye post surgery|
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| Discussion|| |
Ozurdex is a US Food and Drug Administration (FDA)–approved biodegradable, water soluble copolymer of glycolic acid and lactic acid enclosing micronized dexamethasone. Accidental injection of the implant into the lens is a rare but serious complication. An inexperienced surgeon or trainee, inappropriate technique or patient's head movements—all can lead to accidental injection of the implant into the crystalline lens., Lens injury often leads to cataractous changes in days, or even months, after the injection and require intervention.,,, In our case, the patient had developed a cataract; thus, immediate phacoemulsification with IOL implantation and repositioning of Ozurdex into the vitreous cavity were done.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]