Surgical management with preservation of inadvertent intra-lenticular sustained-release dexamethasone implant (Ozurdex) and implantation of three-piece sulcus intraocular lens: A video report
Talabhaktula Krishna, Ajay Sharma, Manali GajmalBackground:
Inadvertent intra-lenticular injection of a sustained-release dexamethasone implant (Ozurdex®; Allergan, Inc., Irvine, CA, USA) is a rare but documented complication of intravitreal therapy for macular edema, often resulting from improper technique or patient movement during injection. [1-3] This report describes surgical retrieval and preservation of an intra-lenticular Ozurdex implant with sulcus three-piece intraocular lens (IOL) implantation.
Purpose:
During surgery, preservation of the implant is technically challenging but beneficial, as it maintains sustained steroid delivery and avoids the need for reinjection, thereby reducing procedure-related risks burden of cost of another injection. [2] Timely recognition and individualized management remain critical for optimal anatomical and functional outcomes. [1,3]
Synopsis:
A 61-year-old male known case of inferotemporal branch retinal vein occlusion with recurrent cystoid macular edema in the right eye (OD) was advised injection Ozurdex. He presented with complications of an intra-lenticular Ozurdex implant in the OD due to sudden head movement, which was confirmed on the first postoperative day. The patient was planned for OD pars plana vitrectomy with pars plana lensectomy and three-piece IOL in sulcus. We planned to preserve the same intravitreal Ozurdex implant
Highlights:
This case highlights that timely surgical intervention allows safe removal and preservation of the Ozurdex implant, ensuring continued steroid delivery while addressing cataract formation. The above complication can be prevented by proper patient counselling, adequate anesthesia, 4 mm distance marking from the limbus in phakic cases, and maintaining the direction of the needle towards the centre of the globe while injecting. Meticulous surgical planning and gentle handling of the implant are crucial for achieving favorable anatomical and functional outcomes in such challenging scenarios.
Video Link:
https://youtu.be/eEL_PurUnvw