Protracted Intralenticular Implant of Sustained-Release Dexamethasone Implant (Ozurdex)

Introduction

The Ozurdex implant was designed to obtain a slow release of dexamethasone over a period of several months for the treatment of macular edema in the context of diabetic retinopathy or retinal vein occlusion, or in the treatment of noninfectious uveitis [1] [2] [3]. The treatment is administered through an intravitreal injection (IVT), and in the vitreous, it releases dexamethasone gradually over time, reducing inflammation and fluid buildup in the macula, thereby improving vision. Complications related to Ozurdex treatment are mostly ascribed to the known side effects of corticosteroid administration to the eye, namely, increased intraocular pressure (IOP), glaucoma, and cataract formation [4]. However, the risks caused by an IVT should be carefully weighted when considering an Ozurdex implant. Indeed, albeit very rare, cases of endophthalmitis have been reported [5]. Here, we present a case of another very rare complication, the inadvertent implantation of the Ozurdex implant into a crystalline lens.

Publication History

Received: 28 October 2023

Accepted: 15 November 2023

Article published online:
23 April 2024

• References

• 1 Haller JA, Bandello F, Belfort jr. R. et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology 2011; 118: 2453-2460
• 2 Lowder C, Belfort jr. R, Lightman S. et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 2011; 129: 545-553
• 3 Boyer DS, Yoon YH, Belfort jr. R. et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014; 121: 1904-1914
• 4 Gaballa SA, Kompella UB, Elgarhy O. et al. Corticosteroids in ophthalmology: drug delivery innovations, pharmacology, clinical applications, and future perspectives. Drug Deliv Transl Res 2021; 11: 866-893
• 5 Celik N, Khoramnia R, Auffarth GU. et al. Complications of dexamethasone implants: risk factors, prevention, and clinical management. Int J Ophthalmol 2020; 13: 1612-1620
• 6 Schmitz K, Maier M, Clemens CR. et al. [Reliability and safety of intravitreal Ozurdex injections. The ZERO study]. Ophthalmologe 2014; 111: 44-52
• 7 Meyer CH, Rodrigues EB, Michels S. et al. Incidence of damage to the crystalline lens during intravitreal injections. J Ocul Pharmacol Ther 2010; 26: 491-495
• 8 Rosenfeld PJ, Brown DM, Heier JS. et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355: 1419-1431
• 9 Chalioulias K, Muqit MM. Vitreoretinal surgery for inadvertent intralenticular Ozurdex implant. Eye (Lond) 2014; 28: 1523-1524
• 10 Berarducci A, Sian IS, Ling R. Inadvertent dexamethasone implant injection into the lens body management. Eur J Ophthalmol 2014; 24: 620-622
• 11 Clemente-Tomas R, Hernandez-Perez D, Neira-Ibanez P. et al. Intracrystalline Ozurdex^®: therapeutic effect maintained for 18 months. Int Ophthalmol 2019; 39: 207-211
• 12 Regan KA, Blake CR, Lukowski ZL. et al. Intralenticular Ozurdex^® – One Year Later. Case Rep Ophthalmol 2017; 8: 590-594
• 13 Poornachandra B, Kumar VBM, Jayadev C. et al. Immortal Ozurdex: A 10-month follow-up of an intralenticular implant. Indian J Ophthalmol 2017; 65: 255-257
• 14 Chhabra R, Kopsidas K, Mahmood S. Accidental insertion of dexamethasone implant into the crystalline lens–12 months follow-up. Eye (Lond) 2014; 28: 624-625
• 15 Baskan B, Cicek A, Gulhan A. et al. Ozurdex completely located inside a crystallized lens – Results of 14 months. Am J Ophthalmol Case Rep 2016; 4: 38-40
• 16 Albuainain A, Al Jindan M, Al Bloushi B. Surgical removal of inadvertent intralenticular sustained-release dexamethasone implant (ozurdex) and implant one-piece posterior capsule intraocular lens. Saudi J Ophthalmol 2020; 34: 145-147