Abstract
Purpose: :
The iridectomy performed during an iris claw intraocular lens implantation is supposed to prevent pupillary block but can be problematic if an intravitreal injection is required.
Methods: :
We report two cases of pseudophakic patients with iris claw lens and inferior iridectomy. An intravitreal injection of dexamethasone (Ozurdex®Allergan Inc., Irvine, CA, USA) was performed for a refractory macular edema secondary to posterior segment surgeries, and for which the intravitreal implant has migrated into the anterior chamber. The 2 cases are documented with specular microscopy.- The first case is about a 69 year old woman (iris claw on anterior side of iris) who received an intravitreal injection (IVT) of triamcinolone (TA). TA was effective on macular edema but complicated by a pseudo endophthalmitis one day later, because of the migration of TA crystals in the anterior chamber.Five months later a dexamethasone IVT (off-label) was performed. Two days later, the implant had migrated into the anterior chamber. Its direct contact with the corneal endothelium induced an important corneal edema. The removal was performed in emergency, without technical difficulty. The corneal edema decreased in 7 days.- The second case involved a 50 year old man with an iris claw lens on the posterior surface of the iris. The Dexamethasone implant remained six days in the anterior chamber. The important corneal edema regressed only after 30 days. The surgical removal was more difficult after 6 days with a brittle implant in the forceps.
Results: :
These cases illustrate the fact that intravitreal corticosteroids injections are not always well tolerated. Pseudoendophtalmitis cases, well known with TA, underline the difficult problem of differential diagnosis with endophthalmitis.Because of the recent commercialization of the dexamethasone implant , the risk of its use in the pseudophakic eyes with iris claw lens is not well evaluated. We report 2 cases of intravitreal implant migration in the anterior chamber by an inferior iridectomy with 2 different positions of iris claw lens (anterior and posterior).The removal of the dexamethasone implant must be made without delay because of the risk of endothelial toxicity and induced corneal edema. The 2 cases illustrate this latter point with a removal at different times (day 2 and day 6) with a different evolution of the edema. The corneal edema can require a keratoplasty if the implant is removed later as it was recently reported by Lopez Pardo et al. about one case.
Conclusions: :
This complication is not well documented in the literature. The dexamethasone implant must be used with precaution in pseudophakic eyes with iris claw lens and iridectomy as in patients with zonular rupture.
Keywords: corticosteroids • anterior chamber • drug toxicity/drug effects