Successful management of intralenticular Ozurdex injection causing cataract and intractable glaucoma

Kalpa Negiloni,Ronnie Jacob George,Shwetha Tripathi,Sridharan Sudharshan

doi:10.35119/asjoo.v17i2.575

Abstract

A 50-year-old female presented with profound vision loss and was previously advised injection Ozurdex in the left eye. In the left eye, the anterior chamber was quiet, intraocular pressure (IOP) was 58 mmHg and cataractous changes were noted with Ozurdex implant inside the lens substance. The left eye had glaucomatous cupping (0.9:1 CDR), bipolar rim thinning, inferior notch and healed choroiditis. The patient underwent phacoemulsification, trabeculectomy and mitomycin-C in the left eye. Visual acuity improved and IOP was under control. Although Ozurdex is effective, there are reports of complications related to the drug and implantation procedure. This case highlights an uncommon complication of an uncontrolled, persistent steroid response leading to glaucomatous optic atrophy and profound vision loss due to an accidental intralenticular implantation of Ozurdex. Our case reinforces the need for caution about the decision regarding the judicious use of intravitreal steroids and employment of appropriate technique.

Highlights

Intravitreal corticosteroid implants are widely available options for the treatment of macular oedema, non-infectious posterior uveitis, diabetic retinopathy, retinal venous occlusions and others
George, Sudharshan, Tripathi glaucomatous cupping and cataract due to accidental intralenticular injection of Ozurdex treated for geographic helicoid peripapillary choroiditis (GHPC)
Our case highlights an uncommon complication of an uncontrolled, persistent steroid response leading to glaucomatous optic atrophy and profound vision loss due to an accidental intralenticular implantation of Ozurdex

Summary

Introduction

Intravitreal corticosteroid implants are widely available options for the treatment of macular oedema, non-infectious posterior uveitis, diabetic retinopathy, retinal venous occlusions and others. A 50-year-old female presented to us with diminished vision in the right eye since 10 years and left eye in the last 2 months She had been diagnosed with GHPC in both the eyes and had been administered injection Ozurdex in the left eye, 9 months ago. Her visual acuity recorded 2 months ago was 20/200 in the right eye and perception of light with inaccurate projection of rays in the left eye. The left-eye anterior chamber was quiet, with cataractous changes and Ozurdex implant inside the lens substance with a visible posterior capsule entry site (Fig. 1). Post-operatively, the IOP was 6 mmHg on first day and was maintained at 18 mmHg at 1 week and thereafter Her visual acuity improved to counting fingers at 3 m.

Discussion

Conclusion