Management and Complications of Dexamethasone Intravitreal Implant Migration Into the Anterior Chamber

Abstract

Purpose: To report patient demographics, the clinical course, and visual outcomes across a case series of patients who experienced dexamethasone (DEX) intravitreal implant (Ozurdex, Allergan, Inc) migration into the anterior chamber (AC), with a focus on the corneal transplantation rate. Methods: In this retrospective cross-sectional study, a chart review of all cases was performed. For numerical responses, means and SDs were calculated. Percentages and absolute numbers were used to report the proportion of patients who experienced various outcomes of interest. Results: The study comprised 32 cases. All cases occurred in pseudophakic eyes; of those, 8 (25.0%) had posterior chamber intraocular lenses in the capsular bag with no known capsular or zonular issues. The mean duration from DEX implant injection to detection of migration was 19.4 ± 14.5 days. The DEX implant was explanted in 21 patients (65.6%) and repositioned in the vitreous cavity or subconjunctival space in 6 patients (18.8%). Twelve patients (37.5%) ultimately required corneal transplantation. Conclusions: To our knowledge, this is the largest case series of DEX intravitreal implant migration into the AC compiled to date. Cases of migration occurred in individuals with no known history of significant prior zonule disruption. This potential complication should be discussed with all patients undergoing DEX implant injection, which may aid in earlier presentation and improved visual outcomes.

Subkonjuktivale Dexamethason-Implantation

“…Eine mögliche Komplikation ist die Migration von Ozurdex in die Vorderkammer, die insbesondere bei den Risikofaktoren einer defekten Linsenkapsel, Zonuladialyse, sklerafixierter Linse, Aphakie, periphere Iridotomie und einer Vitrektomie in der Vergangenheit auftreten kann 3 . Seltener wurde eine Migration von Ozurdex bei intakten anatomischen Verhältnissen bei pseudophaken Patienten beschrieben 4 . Als Folge dieser Fehlposition des Ozurdex in der Vorderkammer wurde in einer Fallserie ein konsekutives Hornhautödem in 83% der Fälle beschrieben 5 .…”

Complications of Subconjunctival, Subtenon and Intravitreal Injections During the Procedure, Early and Late Post-procedure period

“…26 Geç kalınan olgularda kornea dekompanzasyonu nedeniyle keraoplasti uygulanması gerekebilmektedir. 27 Anti-VEBF ilaçların ise kornea endotel hücreleri üzerinde hafif değişikliklere yol açtığı speküler mikroskopi çalışmalarında bildirilse de klinik olarak bildirilen olumsuz etkisi bulunmamaktadır.…”