Focal Iris Atrophy Associated with Intracapsular Injection of Dexamethasone Intraocular Suspension 9% in Cataract Surgery

We report a complication of dexamethasone intraocular suspension 9% placed into the capsular bag at the conclusion of cataract surgery. This retrospective case series was performed at an academically affiliated multi-specialty private practice group. Documentation from postoperative visits was evaluated for the development of complications including postoperative pressure spikes, corneal edema, spherule prolapse into the anterior chamber, and changes in pupillary shape. 65 eyes of 45 patients were included in the study. Six of 65 eyes (9.2%) developed pupillary abnormalities, and five of them (83.3%) were preceded by observed prolapse of the dexamethasone spherule into the anterior chamber. In total, nine of 65 eyes (13.8%) demonstrated spherule prolapse, four of which (44.4%) had no effect on pupillary shape. Prolapse of this steroid spherule may correlate with the development of pupillary ovalization, and attempts to eliminate postoperative topical steroids will require delivery systems that prevent steroid-induced iris damage.