Intracrystalline Ozurdex®: therapeutic effect maintained for 18 months.

INTRODUCTION: Ozurdex® is a sterile, sustained-release implant of dexamethasone. The device dissolves within the vitreous body and releases dexamethasone. Here we present a clinical case that demonstrates the sustained therapeutic efficacy of Ozurdex® when accidentally injected into the crystalline lens. METHODS: Case report. RESULTS: Sixty-three-year-old male in which we decided to prescribe the intravitreal injection of a dexamethasone implant (Ozurdex®) in the left eye because of macular oedema after branch retinal vein occlusion. Best-corrected visual acuity (BCVA) was 0.4. At 15 days post-implantation, the slit-lamp examination revealed the dexamethasone implant was located in the crystalline lens. Given there was no inflammation in the anterior pole, no cataracts had developed, the intraocular pressure (IOP) was normal and the macular oedema had been resolved, we decided to assess the efficacy and safety of the dexamethasone implant located in the crystalline lens. The BCVA improved until 14 months post-accidental injection. At 18 months post-Ozurdex® injection the BCVA worsened until 0.05 because of the cataract evolution. Phacoemulsification and intraocular lens placement in sulcus was performed. CONCLUSION: Once the complication has occurred, most authors advocate the early withdrawal of the implanted Ozurdex® device by means of crystalline phacoemulsification and then repositioning it in the vitreous body. However, as long as there are no signs of inflammation in the anterior pole, the IOP is within normal limits, the device does not affect the visual axis and there is no cataract development, we can evaluate the potential therapeutic effect of Ozurdex® in this non-indicated, abnormal location.

Correlation Between Ischemic Retinal Accidents and Radial Peripapillary Capillaries in the Optic Nerve Using Optical Coherence Tomographic Angiography: Observations in 6 Patients.

BACKGROUND: Perfusion of the optic nerve has been widely studied using fluorescein angiography (FAG), which is currently regarded as the criterion standard. However, FAG has adverse effects associated with intravenous contrast administration and is limited in its capacity to characterize and stratify the different vascular layers of the optic nerve and retina. The use of new imaging techniques, such as optical coherence tomographic angiography (Angio-OCT), is therefore important. AIM: A qualitative description is made of the vascular layers of the optic nerve and of how vascular events affect radial peripapillary capillaries (RPC). Two patients with central retinal artery occlusion (CRAO), 1 with arteritic anterior ischemic optic neuropathy (AAION), and 3 healthy subjects were studied. RESULTS: The Angio-OCT imaging afforded better visualization of the depth of the RPC and rest of the vascular layers of the retina compared with FAG. Optic nerve surface perfusion was affected in AAION and proved normal in CRAO. CONCLUSIONS: Our results indicate that perfusion of the papilla and RPC mainly arises from the papillary plexus that depends on the posterior ciliary artery.