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Dexamethasone/ranibizumab Increased intraocular pressure, corneal oedema and no therapeutic response: case report

A 71-year-old woman developed increased intraocular pressure and corneal oedema during treatment with dexamethasone for complicated cataract. Additionally, she exhibited no therapeutic response to dexamethasone and ranibizumab, while being treated for complicated cataract. The woman had undergone a complicated cataract surgery 6 months previously (before current presentation) with a scleralfixated posterior chamber lens implant. She had a single corneal suture and a defective iris at 11 o’clock. She received six intravitreal injections of ranibizumab and one intravitreal injection of dexamethasone implant [Ozurdex; Allergan; dosages not stated], to which she did not respond. Therefore, she underwent uneventful intravitreal injection of continuous-releasable dexamethasone 0.7mg implant, which was injected to 3.5mm from the limbus after topical anaesthesia with proparacaine [proxymetacaine]. Two weeks after implantation, she presented to an emergency clinic with the complaints of pain, decreased vision and foreign body sensation. Visual acuity on the left eye was noted to be 0.1 with pinhole, and she had intraocular pressure of 26mm Hg (increased). Significant corneal oedema was observed, and the dexamethasone implant was noted to have moved in the anterior chamber with an endothelial touch. She had a history of intraoperative floppy iris during cataract surgery that had resulted in capsule rupture and iris defect. Therefore, she had undergone anterior vitrectomy, and scleral-fixated lens was implemented due to capsular support deficiency. Therefore, it was noted that the implant had passed into the anterior chamber through the capsule rupture and iris defect. It was noted that she developed increased intraocular pressure and corneal oedema secondary to dexamethasone [times to reactions onsets not stated]. The woman underwent surgical removal of the implant after 24 hours while she was hospitalised. Postoperatively (at first week), the visual acuity had improved (0.3), and the cornea was clear. Intraocular pressure was noted to have decreased to 14mm Hg. Aytogan H. A case of intravitreal dexamethasone implant migration into the anterior chamber. Turkiye Klinikleri Tip Bilimleri Dergisi: Turkish Journal of Medical Science 803516679 40: 391-392, No. 3, 2020. Available from: URL: http://doi.org/10.5336/medsci.2019-73015

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Reactions 21 Nov 2020 No. 1831