Accidental intralenticular sustained-release dexamethasone (Ozurdex) implantation: A case report

Intravitreal implantation of Ozurdex (Allergan Inc., Irvine, CA, USA), a sustained-release dexamethasone implant, is a common practice in ophthalmology. Inadvertent intralenticular implantation of Ozurdex is a very rare complication. Herein, we report a case of accidental intralenticular Ozurdex implantation. During the intravitreal procedure, the patient moved his head vigorously which resulted in the said complication. He was followed up periodically with monitoring of intraocular pressure (IOP), best-corrected visual acuity, lens status, fundus, and macular edema status. He developed a posterior subcapsular cataract after about 5 months of the procedure. The cataract was removed around 6 months follow-up by phacoemulsification with anterior vitrectomy and implantation of a 3-piece posterior chamber intraocular lens in the ciliary sulcus. Macular edema had resolved by 3 months of Ozurdex implantation and the patient did not require a second intravitreal dose. He was well at 3 months follow up after cataract surgery.

Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy

Purpose. To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy. Methods. All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed. Results. The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value ( P = 0.818 , 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (−5.5)–(+6)), the mean cylindrical value was −1.7 ± 2.4 D (min-max, (−9.25)–(+4)), and the mean spherical equivalent value was −0.5 ± 2.3 D (min-max, (−6.5)–(+6)). Conclusion. The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.

Challenges of Pediatric Cataract Surgery in a Case of Seasonal Hyperacute Panuveitis (SHAPU)

A four-year-old female child diagnosed as a case of severe Seasonal Hyperacute Panuveitis (SHAPU) underwent lens-sparing core vitrectomy in her left eye with intravitreal antibiotic and steroid. Patient responded well to treatment and intraocular inflammation subsided. However, three months later, she developed vision impairing dense cataract which also made posterior segment assessment difficult. Lens aspiration with primary posterior capsulotomy and anterior vitrectomy with intraocular lens (IOL) implantation was performed. However, four weeks later, the patient developed occlusio pupillae with iris bombe. She did not respond to medical management so synechiolysis with surgical iridectomy was performed after which a normal depth anterior chamber was attained. Synechia and iris bombe were also relieved, and vision was regained.

Conventional Approach Versus Lensectomy with Anterior Vitrectomy in Congenital Cataract - A Comparative Study from Meerut, India

BACKGROUND We wanted to compare lensectomy with anterior vitrectomy and conventional methods in the surgical management of congenital cataract. METHODS The present study is an interventional analytical study that entailed 30 patients (33 eyes) of bilateral or unilateral congenital cataract who attended the Ophthalmology outpatient department of LLRM Medical College, Meerut, during the period extending from March 2018 to March 2019. 19 of these patients (63.3 %) were males while 11 (36.7 %) were females. Age of the patients varied from 2 years to 12 years, with a mean age of 5 years 7 months. The maximum number of patients was in the age group of 4 - 8 years in either sex. RESULTS Being a comparative analysis, this study had 39.3 % cases treated by conventional methods and 60.7 % cases managed by lensectomy and anterior vitrectomy. The visual acuity was compared in the conventionally treated patients and lensectomy and anterior vitrectomy treated patients. Amongst the patients managed by conventional methods, 37.5 % had good vision, 12.5 % had fair vision and 50.0 % poor vision. In the lensectomy and anterior vitrectomy treated group, 61.1 % cases had good vision, 22.2 % had fair vision and only 16.7 % had poor vision. Comparing the occurrence of complications in both groups, the conventionally treated group showed an incidence of 32.4 % as compared to 4.4 % in lensectomy and anterior vitrectomy treated group. CONCLUSIONS The lensectomy and anterior vitrectomy treated groups had good vision and fewer complications as compared to the conventional methods. KEY WORDS Cataract, Visual Acuity, Lensectomy, Vitrectomy

Double-Needle Yamane Technique Using Flanged Haptics in Ocular Trauma—A Retrospective Survey of Visual Outcomes and Safety

To evaluate visual outcomes and safety of the double-needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double-needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow-up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow-up at three months. Further studies with longer follow-up evaluations are required to verify long-term complications.

Management of cataracts secondary to intravitreal chemotherapy injections for retinoblastoma seeding

Purpose: To report our experience in the management of cataracts presumably due to intravitreal chemotherapy administration in eyes with vitreous disease associated with retinoblastoma. Methods: This retrospective study consisted of a cohort of five eyes of five retinoblastoma patients who developed cataracts secondary to intravitreal chemotherapy administration and who then underwent cataract surgery. All patients underwent lensectomy and anterior vitrectomy with/without intraocular lens implantation via clear corneal approach. All cases were administered intraoperative intravitreal melphalan (35–40 mcg) and topotecan (10–20 mcg) at the end of cataract surgery as a preventive measure against retinoblastoma spread. Injections were repeated as needed in monthly follow-ups. Main outcome measures were enucleation rate and disease-free survival time. Results: The age at surgery ranged between 5 and 10 years. Follow-up time varied from 12 to 16 months. Treatment-free period before surgery ranged between 3 and 20 months. Time from last injection to cataract detection was: 2, 2, 10, 6, and 7 months; and time from last injection to cataract surgery was: 8, 3, 20, 7, and 15 months in cases 1–5, respectively. None of the eyes required enucleation. Tumor control was achieved in all patients at the end of follow-up. Conclusions: Injection of melphalan and topotecan into anterior parts of the vitreous may lead to cataract formation. This can be safely managed with lensectomy and anterior vitrectomy and the use of intravitreal administration of melphalan and topotecan at the conclusion of the surgery as a precautionary measure against the potential risk of extraocular spread.

Outcome of cataract surgery in children affected by malignancies other than retinoblastoma with eye-lens radiation exposure

Purpose: To describe, retrospectively, the visual outcome, feasibility, and safety of cataract surgery in a pediatric population affected by iatrogenic cataract, secondary to systemic oncological treatment for malignancies other than retinoblastoma. Methods: Young patients, affected by radiation-induced cataract, who were referred to the San Paolo Ophthalmic Center in Padova between 2010 and 2017, were included in the study. All patients had previously received radiotherapy and/or chemotherapy treatment for malignancies, between 2004 and 2013. All medical records of infants who underwent cataract surgery were accurately reviewed. Results: Eighteen eyes out of 11 patients included in the study underwent cataract surgery. The mean age at surgery was 9.7 ± 3.6 years. The interval between tumor diagnosis and cataract development was around 3 years. Mean follow-up after surgery was 15.4 ± 6.3 months. All eyes underwent posterior chamber intraocular lens implantation, posterior capsulotomy, and anterior vitrectomy in one time surgery. No intraoperative complications were shown. Post-operatively, only one eye received laser capsulotomy due to posterior capsule opacification. At the end of follow up, best-corrected visual acuity was 20/20 (LogMAR 0) in all eyes and significantly improved ( p < 0.01) compared to baseline. Conclusions: Iatrogenic-cataract surgery in pediatric oncological patients is a safe and effective way to improve visual acuity. Posterior capsulotomy and anterior vitrectomy at the time of surgery reduce the rate of posterior lens opacification and guarantee an excellent visual acuity in these patients.