背景:玻璃体内注射地塞米松(DEX)可用于治疗糖尿病性视网膜病变引起的黄斑水肿,视网膜静脉阻塞和葡萄膜炎。最常见的并发症是白内障和眼内压(IOP)升高。将DEX植入物意外注射到晶状体中是罕见的并发症,只有很少的论文介绍了它。
方法:一名40岁男性患者接受DEX植入治疗,治疗双眼糖尿病性黄斑水肿。在1周的随访中,裂隙灯检查显示DEX植入物位于右眼(RE)的晶状体中,没有任何炎症迹象,白内障或IOP升高,所以我们决定计划一个正常的后续时间表。左眼注射后5个月黄斑水肿复发(LE),而RE没有显示任何视网膜内或视网膜下液的声音。DEX植入后六个月,由于IOP升高,在RE中进行了顺利的超声乳化和人工晶状体放置。
结论:DEX植入物的治疗效果可以比玻璃体内植入物维持更长的时间,确定黄斑水肿的完全重吸收。晶状体内植入物可以保持在晶状体内,直到眼压增加,白内障进展,或发生其他并发症。
BACKGROUND: Intravitreal dexamethasone (DEX) implant is indicated for the treatment of macular oedema due to diabetic retinopathy, retinal vein occlusion and uveitis. The most common complications are cataract and elevated intraocular pressure (IOP). Accidental injection of DEX implant into the lens is a rare complication and only few papers presented it.
METHODS: A 40-year-old man was treated with DEX implant for diabetic macular oedema in both eyes. At 1 week follow-up visit, slit lamp examination showed the DEX implant was located in the crystalline lens of the right eye (RE) without any sign of inflammation, cataract or elevated IOP, so we decided to plan a normal follow-up schedule. Macular oedema relapsed 5 months after the injection in the left eye (LE), whereas the RE did not show any sing of intraretinal or subretinal fluid. Six months after DEX implantation an uneventful phacoemulsification and intraocular lens placement were performed in the RE because of IOP elevation.
CONCLUSIONS: The therapeutic effect of DEX implant can be maintained for a longer period of time than intravitreal implant, determining complete reabsorption of macular oedema. Intralenticular implant can be maintained inside the lens until either IOP increases, cataract progresses, or other complications occur.