The most commonly performed ocular invasive procedure performed in the USA is the intra-vitreal injection, with many millions done per year. This is far more than the cataract volume which is about 4,000,000 surgeries per year in the USA. So many different retinal conditions benefit from intra-vitreal injections of anti-VEGF, steroids, and other medications: diabetic retinopathy, vascular occlusive disease, age-related macular degeneration, and more. But no procedure is without risk and that means that rarely, the injection may hit the crystalline lens and puncture the lens capsule. When this happens, a cataract tends to develop in days to weeks since the lens proteins are now exposed and will swell and induce inflammation.
Our guest surgeon is Steve Safran MD from New Jersey, USA and he is a well-known master of these tough cases. Here he shows us his technique of successfully dealing with this complication. He is able to complete the case without any vitreous prolapse and without loss of lens material into the vitreous cavity.
Click to learn how to deal with a punctured lens capsule from an intra-vitreal injection:
It could be helpful to inject a dispersive viscoelastic into the capsular bag to completely separate the lens fragments and to lift the lens out of the bag for safer removal. The viscoelastic would also push the posterior capsule back and tamponade the posterior capsular hole