A Novel Technique for Repositioning of a Migrated ILUVIEN® (Fluocinolone Acetonide) Implant into the Anterior Chamber

Abstract

IntroductionFluocinolone acetonide (FAc) intravitreal implant (ILUVIEN®; Alimera Sciences Limited, Aldershot, UK) has been approved in the UK for the treatment of chronic diabetic macula edema, insufficiently responsive to available therapies. It is inserted into the vitreous cavity through a 25-gauge needle. Migration of the implant to the anterior chamber (AC) can occur through gaps in the posterior capsule especially in vitrectomized eyes. Early removal of AC-dislocated FAc implant is essential to prevent corneal edema and damage from raised intraocular pressure.AimTo demonstrate a simple and novel technique, with a previous capsular tear, for removal of AC-migrated FAc implant and reinsertion into the vitreous cavity without compromising implant integrity.MethodA side port incision was created with a keratome and an anterior chamber maintainer introduced and secured. Subsequently, a corneal incision was created at 12 o’clock through which a 23-gauge backflush needle (flute needle) was advanced into the anterior chamber and passive suction used to secure the implant. The flute needle was then placed through the defect in the posterior capsule and the exit port blocked, causing loss of suction and allowing the implant to fall into the posterior segment. The sulcus intraocular lens (IOL) was centralized simply by manipulating it approximately 180 degrees to provide adequate anterior capsule support.ResultsThe FAc implant was successfully removed from AC in two patients and reinserted into the vitreous cavity without damage or complications either for the eye or the implant. IOL in both patients were repositioned to close the gap in posterior capsule. After 2 months, the implant remains in the vitreous cavity. This paper presents data from one of these cases.ConclusionUsing 23-gauge flute needle to retrieve dislocated FAc implant is a safe and easy technique.FundingAlimera Sciences Ltd.Electronic supplementary materialThe online version of this article (doi:10.1007/s40123-015-0035-1) contains supplementary material, which is available to authorized users.

Clinical utility of intravitreal fluocinolone acetonide (Iluvien^®) implant in the management of patients with chronic diabetic macular edema: a review of the current literature

“…Migration of FA implants into the anterior chamber has been reported in two eyes of patients with previous complicated cataract surgery and vitrectomy 47. However, the successful repositioning from the anterior chamber into the vitreous cavity, without damage or complications to the eye or the implant, has been reported using a 23-gauge flute needle 48. A theoretical risk of retinal detachment following intravitreal injection of the FA implant has not been demonstrated in the peer-reviewed literature.…”

Dexamethasone Implant Migration through an Iris Coloboma

“…Although Iluvien is designed to provide sustained therapy for a more extended period, it is also free-floating, but smaller in size than Ozurdex, making it even more susceptible to migrate. Only two cases of Iluvien migration have been reported, with both patients suffering from consequent corneal edema [7,8]. Despite being anchored to the sclera, Retisert has also been reported to dislocate to the AC, inducing corneal edema, possibly as a result of medication reservoir dissociation from its sutured strut [9][10][11].…”

Update on corticosteroids for diabetic macular edema

“…Similar to the dexamethasone delivery system, the fluocinolone insert may migrate into the anterior chamber 65 and require surgical repositioning. 66 …”