Management of cataract and uncontrolled high intraocular pressure after inadvertent intralenticular dexamethasone implant injection

Abstract

A 67-year-old man developed macular edema in the left eye as a result of branch retinal vein occlusion. An intravitreal dexamethasone implant (Ozurdex) was injected. Despite macular edema regression 4 weeks later, the corrected distance visual acuity decreased from 0.3 decimal to 0.1 decimal. Anterior segment examination showed the dexamethasone implant was inadvertently injected into the crystalline lens. Although only 1 injection was given, 2 dexamethasone implants were observed, 1 located in the posterior pole of the lens and the other in the anterior vitreous. The intraocular pressure (IOP) was 60 mm Hg. Phacoemulsification surgery was performed. Because of the high IOP, both implants were removed. A 3-piece hydrophobic acrylic intraocular lens was implanted in the ciliary sulcus. At the 3-month follow-up, the visual acuity was 0.6 decimal as a result of the macular complications associated with vein occlusion, the IOP was 18 mm Hg under glaucoma medication, and no complication was observed. © 2018 ASCRS and ESCRS