Objective evaluation of lens clarity after the intravitreal injection of sustained-release dexamethasone implant.

PURPOSE: To evaluate the lens densitometry values in eyes with macular edema secondary to retinal vein occlusion that were treated with intravitreal dexamethasone implants and to compare these data with those of fellow healthy control eyes. SETTING: Ulucanlar Eye Training and Research Hospital, Ankara, Turkey. DESIGN: Prospective case series. METHODS: Patients with unilateral macular edema secondary to retinal vein occlusion who were to be treated with intravitreal dexamethasone implants were recruited. The lens densitometry values measured with Scheimpflug imaging before and 3 months after the injection were compared with those in fellow healthy eyes. RESULTS: Thirty-seven patients (22 with branch retinal vein occlusion and 15 with central retinal vein occlusion) with a mean age of 61.5 years ± 11.4 (SD) (range 37 to 82 years) were included. The mean lens densitometry value at Pentacam densitometry zone 1 was significantly increased in the study eyes at 3 months compared with baseline values (baseline 9.44 ± 0.99; 3 months 9.68 ± 1.24; P = .015). At zones 2 and 3, the mean and maximum lens densitometry values in study eyes and lens thickness were similar at baseline and 3 months after injection (P > .05). The densitometry values in fellow healthy eyes were also similar at baseline and at 3 months. CONCLUSION: The mean lens densitometry value at zone 1 significantly increased from baseline in the study eyes 3 months after the injection of the dexamethasone implant for the treatment of macular edema secondary to retinal vein occlusion. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Intralenticular Sustained-Release Dexamethasone Implant: Is It Still Effective on Macular Edema?

PURPOSE: To report the therapeutic efficacy of an accidentally injected intralenticular sustained-release dexamethasone implant in a patient with macular edema secondary to branch retinal vein occlusion and shortly discuss the management strategy of this rare complication. METHODS: Complete ophthalmological examination and optical coherence tomography imaging were performed at each visit. RESULTS: The implant accidentally caused a posterior capsular tear during the procedure and was injected into the crystalline lens because of an involuntary head movement of the patient. Since the anterior segment was normal, and the resultant cataract and implant itself did not obscure the visual axis, the decision was made to observe the patient with intralenticular implant, preserve the therapeutic effect and avoid reinjection. The macular edema resolved within time, while visual acuity did not show significant improvement due to an increase in lens opacification. The patient underwent phacoemulsification surgery at 7 months after the injection with implantation of posterior chamber IOL into the capsular bag. CONCLUSION: Inadvertent injection of sustained-release intravitreal dexamethasone implant into the crystalline lens is an uncommon but possible complication that is mostly caused by surgeon inexperience, improper technique and uncontrolled head movement during the procedure. Once this complication occurs, early phacoemulsification and repositioning of the implant into the vitreous is the frequently preferred management strategy. However, remarkable decrease in macular edema and visual acuity improvement can also be achieved without an immediate surgical intervention.

Clinical and Demographic Characteristics of Patients with Uveitis Starting Later in Life.

PURPOSE: To evaluate uveitis cases presenting at older ages for the first time. METHODS: We retrospectively analyzed the clinical data related to the 90 eyes of 68 patients who presented with a first episode of uveitis at the age of ≥60 years and were seen at the Uveitis Division of the Ulucanlar Eye Hospital from 1996 to 2013. RESULTS: The location of the uveitis was anterior in 51 (75%) patients. Nine patients (13.2%) presented with panuveitis, 5 (7.3%) with posterior uveitis, and 3 (4.4%) patients with intermediate uveitis. Idiopathic uveitis in 23 (33.8%) and presumed herpetic anterior uveitis in 23 (33.8%) patients were the most common diagnoses, while other diagnostic entities accounted for 22 (32.3%) patients. The most common complications were elevation of intraocular pressure in 17.7%, cystoid macular edema (CME) in 11.1%, and corneal scar in 11.1% of eyes. CONCLUSIONS: While idiopathic uveitis and presumed herpetic anterior uveitis were the most common causes, although in an endemic country, Behçet disease was not a common cause of uveitis in the elderly population.

Microtrauma-induced recurrent hyphema and secondary glaucoma associated with chronic acetylsalicylic acid use.

To report a case of microtrauma-induced recurrent hyphema and secondary glaucoma associated with voluntary chronic acetylsalicylic acid (ASA) use. A 43-year-old male developed advanced glaucoma in his right eye after a two-month followup period of recurrent microhyphema, which had been induced by strong eye-rubbing. In spite of topical and systemic antiglaucoma medication, as well as topical corticosteroid and cycloplegic drugs and bed rest under hospitalization, the hyphema and glaucoma were not controlled. His medical history revealed that he had been using ASA for 2 years in order to prevent heart attacks. We asked the patient to stop ASA intake and the hyphema cleared considerably on the third day after discontinuation of the drug. One week after stopping ASA, trabeculectomy with mitomycin C was performed without any complications. Glaucoma and recurrent hyphema were controlled after surgery without any medical treatment. Chronic ASA intake may cause recurrent hyphema and secondary glaucoma even after a microtrauma. Medical histories of patients must always be taken, especially in cases of prolonged recurrent hyphema.