Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

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.