Surgical management of intralenticular dexamethasone implant: case series describing two distinct surgical approaches

MDThepurposeofthisstudywastodescribe2distinctsurgicaltechniquesforcataractextractionin2patientswithadexamethasoneimplant(DEX-I)accidentlylodgedwithinthecrystallinelens.Thefirstpatient,aged73,developedmacularedemaduetoveinocclusionintherighteye,whilethesecondpatient,aged88,developedmacularedemafromdiabeticretinopathy.BothpatientsunderwentDEX-Itreatment,butinboth cases, because of improper injector placement, and the DEX-I was inadvertently injected into the lens. 3 months after the injection the first patient developed a posterior cataract and was scheduled for cataract surgery. The second patient, aged 88, was scheduled for surgery 1 month after the injection. Hydrodissection was not performed in either case, and phacoemulsification was performed on the portion of the lens containing the DEX-I to release the implant. In the first case, the DEX-I was aspirated using an irrigation–aspirationprobe, followed by intraocular lens (IOL) placement in the capsular bag. In the second case, the DEX-I was pushed in the vitreous through the capsular tear, and then the IOL was placed in the sulcus. No post- operative complications were observed during the 6-month follow-up in both patients. The literature does not provide clear guidance on managing patients with DEX-I embedded in the crystalline lens. This is the first detailed description, to the authors’ knowledge, of the surgical approaches in such cases, emphasizing the importance of adapting the procedure based on the specific complications encountered.