Vitreoretinal surgery for inadvertent intralenticular Ozurdex implant

Sir,

We read with interest the recent report by Chhabra et al.¹ We would like to share a similar rare case that required early vitreoretinal intervention. In our case, a 62-year-old with left branch retinal vein occlusion and macular oedema underwent an Ozurdex injection in another eye unit. The implant was inadvertently injected into the crystalline lens, and the patient presented 2 weeks later to our clinic. The OCT scan confirmed an intralenticular location of the steroid implant with a posterior subcapsular cataract (Figure 1). The OCT scan of the lens confirmed the posterior capsular defects and extent of the cataract. Visual acuity was 2/60 and the OCT scan was unable to penetrate the cataract for macular evaluation. There was no fundus view, and the ultrasound scan showed no retinal breaks. On the basis of the significant cataract, inability to visualise the retina and evaluate the macular oedema, surgery was planned. Intraoperatively, the Ozurdex implant was adherent to the posterior capsule with entry and exit capsular defects present (Figure 1). After nucleus removal, a larger capsule rupture was noted around the Ozurdex implant impact site, and soft lens matter dropped into the vitreous. A complete 23-G vitrectomy was performed, and the Ozurdex implant was resited within the vitreous cavity and a sulcus lens implant inserted. Visual acuity 1 week post surgery was 6/24 with macular oedema, and the patient remains under follow-up at Moorfields. The case by Chhabra et al¹ and our report demonstrate two different scenarios for the management of such a rare complication. We believe that the clinical decision to observe or operate early should be based on the ability of the clinician to manage the primary underlying condition of macular oedema, and this requires relatively clear media.

Figure 1

(Upper) Transillumination photograph showing posterior subcapsular cataract and intralenticular Ozurdex implant. (Lower) OCT scan of the crystalline lens showing posterior lens thickening and vacuolation, with the Ozurdex implant embedded within a posterior capsular defect.