Management and follow‐up of secondary unlikely location of Dexamethasone Implant: between sulcus 3‐pieces IOL and intact posterior capsule

Abstract

AbstractPurposeManagement and follow‐up of secondary unlikely location of Dexamethasone Implant: between sulcus 3‐pieces IOL and intact posterior capsule.MethodsA 66‐year‐old man had a traumatism while cutting wood: he consulted 3 days later for severe endophthalmitis. A CT scan excluded any metallic intraocular foreign body (FB). Initial emergency surgery consisted in phacovitrectomy without implantation, bacteriologic and fungal samples, removal of small wood FB, antibiotic & antifungal intravitreal injections. No zonulolysis was present, no capsular tear occurred. Local and systemic treatment allowed good anatomic recovery. At 1.5‐month he developed Irvine‐Gass syndrome (CME).At 2‐months, conditions allowed secondary implantation with a 3‐pieces IOL in the sulcus due to anterior and posterior capsules fusion. As zonule and lens bag were well preserved, we injected intravitreal DI without adverse event (free in the posterior segment). Forty days after DI injection, he consulted in emergency for a hay straw in his left eye. Actually, the DI migrated to the anterior segment, just between sulcus IOL and intact posterior capsule. He had no pain, no redness, normal IOP, 0.2 logMAR far & near vision, and an impression of a paracentral scotoma. He reported repeated heavy loads lifting with head down in his farm, despite postoperative instructions. Medical treatment based on myotics (isotpopilocarpine), continuation of anti‐inflammatory drops, and prophylactic hypotonizing monotherapy drops associated with monthly complete monitoring (slit lamp/OCT/specular microscopy) was decided in first line‐therapy.ResultsSpontaneous disintegration of this ectopic DI took 2 months: CME disappeared completely in 1.5 month; IOL remained stable; no IOP elevation or endothelial damage occurred; vision went to 0.0 logMAR and paracentral scotoma disappeared.ConclusionsThis ectopic migration leading to DI sandwich enables good healing from a CME. Various options could have been chosen: among YAG capsulotomy, emergency surgery and medical treatment. Here, rigorous monitoring with precise iconographic sequences allows to estimate efficacy, safety and time of resorption in this unlikely location. DI injection should be really discussed for every trauma background.