Dexamethasone implant migration in an eye with congenital glaucoma: A case report and review of the literature

Abstract

Introduction: The dexamethasone (DEX) implant is an FDA approved treatment for diabetic macular edema, non-infectious posterior uveitis, and macular edema secondary to branch or central retinal vein occlusions. We describe a case of anterior chamber (AC) migration of a DEX implant in a patient with a history of congenital glaucoma and perform a review of the literature on this particular complication, summarizing the common risk factors, subsequent complications, and management options. Case description: A 46-year-old female with a history of congenital glaucoma, status post cataract extraction with insertion of intraocular lens, pars plana vitrectomy, and Baerveldt tube implant in the left eye was referred for post-operative cystoid macular edema (CME). The patient underwent insertion of a DEX implant, resulting in improvement in her CME. After the fourth implant was injected, the patient noticed a white line in her eye while looking in the mirror after doing jumping jacks. Slit lamp examination confirmed migration of the implant into the AC. Ultimately, the patient was taken to the operating room, where her implant was removed via bimanual vitrectomy through an anterior approach. Conclusion: This case report and literature review explores the ophthalmic structural changes specific to congenital glaucoma which may have predisposed this eye to anterior migration of the DEX implant. The purpose of this review is to detail the anatomic changes that may increase the risk of anterior chamber implant migration in patients with congenital glaucoma so that physicians may be aware of these risks when selecting patients for this implant.

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management

“…After the second implantation, the YAG laser used to break up implant into fragments which remained in inferior angle but eventually resolved. Patient had Descemet’s stripping endothelial keratoplasty and a Retisert implant Chang et al [ 32 ] Female, 46 years old Three prior uncomplicated ozurdex implants, bilateral congenital glaucoma, PPV, Baerveldt tube, IOL complicated but its prolapse into the sulcus required repositioning Corneal edema Surgical removal via vitrectomy Eadie et al [ 33 ] Male, 48 years old CRVO, previously uncomplicated ozurdex implant, steroid induced glaucoma and trabeculectomy Superficial punctate keratitis with no edema Watch & wait. Implant dissolved D Kumar et al [ 34 ] Patient 1: Male, 61 years old Patient 2: Male, 57 years old 1: glued IOL 2: glued IOL 1: corneal edema 2: corneal decompensation 1: not specified 2: surgical removal via no-touch technique, the implant aligned perpendicularly with incision and explanted with visco-expression by counter pressure on the posterior lip.…”