Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3784-3791
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3784
Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases
Jing Su, Li-Jun Zheng, Xin-Quan Liu
Jing Su, Xin-Quan Liu, Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Li-Jun Zheng, Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200072, China
Author contributions: Su J was a major contributor in acquisition of the data, literature search and manuscript draft. Zheng LJ contributed to analysis of the data and preparation, revision of the manuscript. Liu XQ provided critical revision of the manuscript. All authors read and approved the final manuscript.
Supported by Scientific Research Projects of Shanghai Municipal Health and Family Planning Commission, No. 201640049.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin-Quan Liu, MD, Chief Doctor, Department of Ophthalmology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Road, Shanghai 200032, China. liuxinquan1962@163.com
Telephone: +86-21-64385700
Received: May 26, 2019
Peer-review started: May 27, 2019
First decision: September 9, 2019
Revised: September 30, 2019
Accepted: October 15, 2019
Article in press: October 15, 2019
Published online: November 26, 2019
Abstract
BACKGROUND

Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases. However, the increased frequency and number of intravitreal injections have raised concerns about their side effects. As manipulation during surgery is relatively simple, details of the procedure are easily overlooked. Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures. We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide (TA) with the hope of providing an insight into this treatment.

CASE SUMMARY

Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye, and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye. In view of the patients’ condition and economic constraints, an intravitreal injection of TA was administered. Due to inappropriate manipulation during surgery, the lens was injured. The site of lens injury and clinical manifestations were different in the two cases. Symptomatic treatment and continuous follow-up were carried out. The therapeutic effect following phacoemulsification of the cataract was satisfactory.

CONCLUSION

Well-defined surgical incision under proper anesthesia, sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event. Careful and meticulous phacoemulsification of the cataract is suggested.

Keywords: Crystalline lens, Intravitreal injection, Triamcinolone acetonide, Iatrogenic injury, Case report

Core tip: Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures. We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide. The site of lens injury and clinical manifestations were different in the two cases. Symptomatic treatment and continuous follow-up were carried out. We hope to provide an insight into this treatment.