A DEXAMETHASONE IMPLANT LOCATED IN THE CRYSTALLINE LENS – THE PARTICULARITIES OF THE PHACOEMULSIFICATION SURGERY

Published 2023 - 27th ESCRS Winter Meeting

Reference: P059 | Type: Presented Poster & Poster Submission | DOI: 10.82333/qq5m-mf28

Authors: Rita Teixeira Martins* ¹ , Joana Santos Oliveira ¹ , Claudia Oliveira Ferreira ¹ , Ana Margarida Ferreira ¹ , Margarida Ribeiro ¹ , Fernando Falcão-Reis ¹ , João Paulo Macedo ¹

¹Centro Hospitalar Universitário São João, Porto,Porto,Portugal

Purpose

The dexamethasone intravitreal implant (Ozurdex®) is used in the treatment of diabetic macular edema. Its common complications reported are conjunctival or vitreous hemorrhage, cataract or increased intraocular pressure. The aim of this work is to report the consequences of an accidental dexamethasone intravitreal implant (Ozurdex®) located entirely into the crystalline lens and the particularities of the respective phacoemulsification surgery.

Setting

Centro Hospitalar Universitário de São João, Porto, Portugal.

Methods

The clinical case is presented along with slit lamp photographs, anterior segment and retinal OCT images and records of the surgical steps.

Results

A sixty-years-old man was followed in our department due to diabetic macular edema and an intravitreal dexamethasone implant (Ozurdex®) was decided to be done in his right eye (RE). The patient missed the appointment fifteen days later. Four months later, he complained of vision loss (from 4/10 to 2/10 RE). In the slit-lamp observation, it was observed the Ozurdex® implant into the crystalline lens. There was no progression of the pre-existing cataract, the intraocular pressure was normal, and no inflammation was identified in anterior segment. Surprisingly, the retinal OCT showed an improvement of the macular edema. Due to decrease visual acuity, the patient was proposed to surgery and a phacoemulsification surgery with three piece intraocular lens implanted in sulcus associated with anterior vitrectomy was done. Hydrodissection and hydrodelineation were not performed to avoid the aggravation of the foreseeable posterior capsular rupture. The reposition of the implant in the vitreous cavity was not successful.

Conclusion

Intraocular injections have associated risks and greater caution should exist in less cooperative patients. The dexamethasone implant in the crystalline lens can maintain its therapeutical effect so surgery can sometimes be postponed. In cataract surgery, the possibility of a posterior capsular rupture is high, so it is important to have extra caution in the hydromaneuvers. Anterior segment OCT may help to better understand the location and entry point of the implant in the lens.