Re: Adherence to NICE guidelines for new glaucoma referrals

Abstract

CommentOzurdex release sustained levels of dexamethasone and biological activity for 6 months and very few implants are seen after 270 days. 1 Case reports of migration of the Ozurdex implant into the anterior chamber of pseudophakic patients exist. 2,3 Patients in whom the posterior capsule of the lens is absent or has a tear are at risk of implant migration into the anterior chamber. The muzzle velocity of the Ozurdex implant is known to have a high initial velocity at 0.8 m/s that decreases exponentially over distance especially in vitreous. 4,5 In our case, the implant was not immediately seen on the slit lamp examination after injection because the high velocity of the implant caused the implant to be lodged superiorly. However, as the patient did not have a posterior vitreous detachment, the implant gradually migrated into the hyaloid fossa (saucer-shaped depression between the lens and the anterior vitreous) and the implant came into view ( Figure 1d). As it had not migrated into the anterior chamber, there was no risk of ocular complications such as corneal oedema. Therefore, the implant was not removed and it eventually dispersed away without causing any complications.