Anterior Chamber Migration of Dexamethasone Intravitreal Implant (Ozurdex®) through Basal Iridectomy (Ando) in a Pseudophakic Patient

Stepanov, Alexandr; Codenotti, Marco; Ramoni, A.; Prati, M.; Jirásková, N; Rozsíval, P; Bandello, Francesco

doi:10.5301/ejo.5000715

Cited by 20 publications

(15 citation statements)

References 8 publications

(8 reference statements)

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“…In the presented case, the patient had an intact posterior capsule. As discussed by Stepanov et al [4], an iris defect that is situated in the inferior iris (as in our case) is more susceptible to be a route of passage for an implant, as it usually sinks to the bottom of the vitreous cavity.…”

Section: Discussionmentioning

confidence: 54%

“…First was Stelton et al [5], who described a patient with PCIOL and a disrupted posterior capsule that also had a large peripheral inferior iridectomy. Later, Stepanov et al [4] described a patient that underwent inferior iridectomy due to silicone oil insertion during pars plana vitrectomy for treating retinal detachment, which was later on implanted with iris-claw ACIOL (Artisan). Although it is fairly likely that in both cases the implant migrated through the iris defects, both patients also had the "classic" risk factors (prior pars plana vitrectomy and disrupted lens capsule).…”

Section: Discussionmentioning

confidence: 99%

“…The main risk factors for device migration are open or defective lens capsule and prior history of vitrectomy [2,3]. Recently, Stepanov et al [4] and Stelton et al [5] reported of implant migration in patients with an iris defect, suggesting it could serve as the migration route. Of note, all the reported cases had, in addition to an iris defect, a defective lens capsule.…”

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confidence: 99%

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Dexamethasone Implant Migration through an Iris Coloboma

Glidai

Schwartz

Cohen

2020

Case Rep Ophthalmol

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Ozurdex ® 0.7 mg (dexamethasone 0.7 mg implant, Allergan, Dublin, Ireland), an intravitreal biodegradable implant, is indicated for cystoid macular edema due to various causes. One of its known and uncommon complications is implant migration to the anterior chamber, causing corneal edema that, in some cases, is irreversible. Reported risk factors for device migration are open or defective lens capsule and prior history of vitrectomy. We present a case of dexamethasone implant migration through a congenital iris coloboma in a pseudophakic patient with an intact lens capsule. The patient is a 56-year-old pseudophakic man with a history of congenital iris coloboma, myopia, retinal tears, and a branch retinal vein occlusion with subsequent cystoid macular edema resistant to anti-VEGF medications but responsive to corticosteroids. He presented with sudden painless decreased vision in his left eye, 8 weeks following dexamethasone implant (Ozurdex) injection to the same eye. Upon presentation, he was diagnosed with corneal edema caused by anterior chamber migration of the implant. He was referred for immediate surgical intervention to extract the implant, with a resolution of the corneal edema within 2 weeks postoperatively. To conclude, this is the first case that reports Ozurdex implant migration through an iris coloboma in the setting of an intact posterior capsule. In addition, we describe a novel surgical approach for implant removal from the anterior chamber that is simple and efficient.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Dexamethasone Implant Migration through an Iris Coloboma

Glidai

Schwartz

Cohen

2020

Case Rep Ophthalmol

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“…Among patients treated with the 0.7 mg insert (the dose that was eventually approved by the FDA) in the 36-month registration trials, 41.5% required topical IOP lowering medications, but only 0.3% required incisional glaucoma surgery. 50 The dexamethasone delivery system may migrate into the anterior chamber in pseudophakic or aphakic eyes, 51 which requires surgical removal ( Figure 2 ). 52 Less frequently reported complications include endophthalmitis, 53 acute retinal necrosis due to varicella zoster virus, 54 and retinal and vitreous hemorrhage due to retinal impact during injection.…”

Section: Dexamethasonementioning

confidence: 99%

Update on corticosteroids for diabetic macular edema

Schwartz¹,

Stewart²,

Flynn³

2016

OPTH

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Diabetic macular edema (DME) remains an important cause of visual loss. Although anti-vascular endothelial growth factor (VEGF) agents are generally used as first-line treatments for patients with center-involving DME, there is an important role for corticosteroids as well. Corticosteroids may be especially useful in pseudophakic patients poorly responsive to anti-VEGF therapies, in patients wishing to reduce the number of required injections, and in pregnant patients. Intravitreal triamcinolone acetonide has been used for many years but is not approved for this indication. An extended-release bioerodable dexamethasone delivery system and an extended-release nonbioerodable fluocinolone acetonide insert have both achieved regulatory approval for the treatment of DME. All intravitreal corticosteroids are associated with risks of cataract progression, elevation of intraocular pressure, and endophthalmitis. There is no current consensus regarding the use of corticosteroids, but they are valuable for selected patients with center-involving DME.

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“…Efficacy and safety of this treatment are well documented. Complications of the implant injections such as migration in the anterior chamber throught iridotomy or in case of aphakia have already been described (Stepanov et al 2015 ). Accidental injections into the crystalline lens (Coca-Robinot et al 2014 ; Fasce et al 2014 ) have also been reported.…”

Section: Introductionmentioning

confidence: 98%