Sir,

It is with great interest that we read another case of Ozurdex implant malpositioned in the crystalline lens, as reported by Chalioulias and Muqit.1

Although the complication is rare, with increasing use of intravitreal implants, the number of accidental malpositioning in the crystalline lens may also increase.

Cataract formation is evidently the major consideration in such cases, due to the active pharmacological ingredient being a steroid in close proximity to the lens matter in addition to the mechanical trauma. The two cases however suggest a variable pace of cataract progression underpinning relevant management decisions.

We fully agree with the authors that clinical management of each case should be individualized and based on concomitant findings and the development of any side effects.

The authors have taken an approach of early intervention prompted by rapid formation of dense cataract precluding fundal view. In our case, however, gradual cataract progression and media clarity for an extended period of time allowed for an approach of careful watch and wait.

During this course the therapeutic effects of the implant, albeit intralenticular, became quite obvious with resolution of CMO.

As an update on our case, we report no recurrence of CMO at 21 months follow-up with no need for any additional therapeutic intervention.

It was an engrossing case report and we commend the authors on a positive outcome.