A Useful Intralenticular Foreign Body


RETINA PHOTO






SUMMARY

Fifty-one-year-old man with right cystoid macular edema (CME), following a superior branch retinal vein occlusion a month before, that presented to our institution with a dexamethasone intravitreal implant lodged in the lens. The patient was submitted to cataract surgery and 23G pars plana vitrectomy with endophotocoagulation of the ischemic retinal quadrant, after which the dexamethasone intravitreal implant was moved back to the vitreous cavity through the already torn posterior capsule. Ten days after surgery BCVA was 20/50 with marked improvement of CME, as seen in OCT imaging.


ABSTRACT

Purpose:

To report the case of a fifty-one-year-old man with right cystoid macular edema (CME), following a superior branch retinal vein occlusion a month before, that presented to our institution with a dexamethasone intravitreal implant lodged in the lens.

Methods:

Case report fully documented through clinical records, anterior and posterior segment digital photography, optical coherence tomography and surgical video. After a full ophthalmological exam, optical biometry and spectral-domain optical coherence tomography (OCT) the patient underwent surgery. Preoperative best-corrected visual acuity (BCVA) was 20/400 and IOP was 13 mmHg. Slit-lamp examination showed a quiet eye, with an intact anterior lens capsule, visually significant cataract and a dexamethasone intravitreal implant within the lens nucleus. Fundoscopy was remarkable for flame-shaped hemorrhages and cotton wool spots in the temporal superior vascular arcade, with marked CME.

Results:

The surgery was initiated by continuous curvilinear capsulorhexis, hydrodelineation and phacophagia of the lens with the I&A (irrigation and aspiration) handpiece. To prevent accidental aspiration of the dexamethasone implant, its fragments were temporarily moved to the iridocorneal angle using cohesive viscoelastic. This was followed by 23G pars plana vitrectomy (PPV) and endophotocoagulation of the ischemic retinal quadrant. The dexamethasone implant fragments were then moved back into the vitreous cavity through the already torn posterior capsule. Finally, a 3-piece foldable IOL was inserted in the ciliary sulcus. The immediate post-operative period was uneventful. Ten days after surgery BCVA was 20/50 with marked improvement of CME, as seen in OCT imaging. IOP was 13 mmHg and the IOL was well positioned in the ciliary sulcus. The patient was very satisfied.

Conclusions:

No procedure, no matter how simple it seems, is free of complications and the surgeon must be prepared to handle the unexpected. By using a creative approach, it was possible to simultaneously solve the complication (cataract surgery and IOL insertion) and salvage the implant (moved back to the vitreous cavity), obtaining an excellent early postoperative anatomical and functional result.


CONTACT DETAILS

Filipe Henriques
Coimbra, Portugal
Email : filh1967@gmail.com
Cell Phone: +351918362497
Work Phone: +351916191052