Atlas of Ophthalmology

Inadvertent Injection of Dexamethasone Implant Ozurdex® into Crystalline Lens (Colour Photography Anterior Segment)

Cristalino -> Trauma
Patient: 57 years of age, BCVA 0.5, IOP 17 mmHg. Ocular Medical History: due to macular edema in unilateral retinal vein occlusion an intravitreal injection of Ozurdex® was performed. During the procedure, the implant was accidentally injected into the crystalline lens. The patient did not complained of blurred vision. Ozurdex implant was detected on routine biomicroscopy as a white foreign body in the capsular bag. Phacoemulsification was performed 4 months later for cataract formation. An uncomplicated fixation of the intraocular lens (IOL) into the capsular bag was enabled due to fibrosis of the capsular defect. General Medical History: arterial hypertension. Main Complaint: none. Purpose: to show the intracapsular location of the Ozurdex® implant after inadvertent injection. Methods: Colour Photography Anterior Segment. Findings: Colour Photography Anterior Segment: a shiny-yellowish reflex, corresponding to the implant, is observed in the superotemporal quadrant of the lens. The implant is located in the capsular bag at 2h position. Discussion: Few complications involving the anterior segment have been reported after injection of intravitreal dexamethasone implants. Koller et al. 2012 (1), described cataract surgery after implant in the crystalline lens. Risk factors for an inadvertent placement of Ozurdex® were the 22-gauge injector with a relatively large diameter compared to 28- or 30-gauge needles used for anti-VEGF treatment, and the requirement of a considerable pressure on the globe. In addition, the pain experienced by the patient may provoke inadvertent eye or head movements. Lens damage can be a complication of dexamethasone implant. Literature: (1) Koller S, Neuhann T, Neuhann I. Conspicuous crystalline lens foreign body after intravitreal injection. Ophthalmologe. 2012 Nov;109(11):1119-21

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