Surgical repositioning of iatrogenic intralenticular steroid implant

Amit S Nene; Madhuri Meshram; Aniruddha S Nibhorkar; Pratik Shenoy; Pushpanjali Badole; Smitesh Shah; Onkar H Pirdankar

doi:10.4103/ijo.IJO_2004_22

PHOTO ESSAY

Year : 2023 | Volume : 3 | 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

Correspondence Address:
Onkar H Pirdankar
Isha Netralaya, Karnik Road, Kalyan West, Maharashtra
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_2004_22

Abstract

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 1: OCT of right eye showing chronic macular edema (CME)

Click here to view

Figure 2: Intralenticular Ozurdex implant

Click here to view

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

Click here to view

Figure 4: Slit-lamp anterior segment photo and OCT of the right eye post surgery

Click here to view

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.^[1],[2] Lens injury often leads to cataractous changes in days, or even months, after the injection and require intervention.^{[1],[3],[4],[5]} 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

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Sekeroglu MA, Anayol MA, Koc F, Tirhis H, Ozkan SS, Yilmazbas P. Intralenticular sustained-release dexamethasone implant: Is it still effective on macular edema. Case Rep Ophthalmol 2016;7:85-9.
2.	Yap JF, Wai YZ, Ng QX, Lim LT. Iatrogenic intralenticular broken steroid implant: A case report. J Med Case Rep 2019;13:1-3. doi: 10.1186/s13256-019-2064-1.
3.	Kurt A, Durukan AH, Küçükevcilioğlu M. Accidental intralenticular injection of Ozurdex® for branch retinal vein occlusion: Intact posterior capsule and resolution of macular edema. Case Rep Ophthalmol Med 2019;2019:1–4. doi: 10.1155/2019/8630504.
4.	Poornachandra B, Kumar VBM, Jayadev C, Dorelli SH, Yadav NK, Shetty R. Immortal Ozurdex: A 10-month follow-up of an intralenticular implant. Indian J Ophthalmol 2017;65:255-7. [PUBMED] [Full text]
5.	Coca-Robinot J, Casco-Silva B, Armadá-Maresca F, García-Martínez J. Accidental injections of dexamethasone intravitreal implant (Ozurdex®) into the crystalline lens. Eur J Ophthalmol 2014;24:633-6.