Intralenticular Sustained-Release Dexamethasone Implant: Is It Still Effective on Macular Edema?

PURPOSE To report the therapeutic efficacy of an accidentally injected intralenticular sustained-release dexamethasone implant in a patient with macular edema secondary to branch retinal vein occlusion and shortly discuss the management strategy of this rare complication. METHODS Complete ophthalmological examination and optical coherence tomography imaging were performed at each visit. RESULTS The implant accidentally caused a posterior capsular tear during the procedure and was injected into the crystalline lens because of an involuntary head movement of the patient. Since the anterior segment was normal, and the resultant cataract and implant itself did not obscure the visual axis, the decision was made to observe the patient with intralenticular implant, preserve the therapeutic effect and avoid reinjection. The macular edema resolved within time, while visual acuity did not show significant improvement due to an increase in lens opacification. The patient underwent phacoemulsification surgery at 7 months after the injection with implantation of posterior chamber IOL into the capsular bag. CONCLUSION Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but possible complication that is mostly caused by surgeon inexperience, improper technique and uncontrolled head movement during the procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy. However, remarkable decrease in macular edema and visual acuity improvement can also be achieved without an immediate surgical intervention.