Management of Anterior Chamber Migration of Dexamethasone Intravitreal Implant

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

“…Implant dissolution Kayıkçıoğlu et al [ 11 ] Patient 1: Male, 63 years old Patient 2: Female, 60 years old Patient 3: Male, 61 years old Patient 4: Female, 79 years old Patient 5: male, 73 years old Patient 6: Male, 70 years old 1: Posterior capsular rupture, zonular dialysis, PPV, sulcus IOL 2: PPV and sutured IOL 3: Diabetic retinopathy, PPV, PC IOL 4: PPV, sutured IOL 5: PPV, anterior vitrectomy, scleral fixated IOL 6: PPV, scleral fixated IOL 1: permanent bullous keratopathy 2: corneal edema and retinal detachment 3: corneal edema 4: no complications 5: bullous keratopathy 6: bullous keratopathy, rise in IOP 1: implant aspiration and keratoplasty 2: pupil dilation, corneal manipulation, patient posturing (reverse Trendelenburg) 3: surgically repositioned using 23 g catheter 4: pupil dilation, corneal manipulation, patient posturing (reverse Trendelenburg) 5: surgical repositioning but then aspirated after re-migration. Keratoplasty 6: aspiration of implant and keratoplasty Stewart [ 18 ] Male, 43 years old Posterior uveitis No complications Removal via a technique which involved injection of viscoelastic and corneal incision depression Ha et al [ 19 ] Patient 1: Male, 64 years old Patient 2: Male, 49 years old 1: Zonular dialysis, PPV, Scleral fixated IOL 2: Defective lens capsule, PPV, Scleral fixated IOL 1: corneal edema 2: corneal edema 1: repositioning with globe massaging 2: repositioning with globe massaging but re-migrated 3 times. Surgical removal was used eventually Kang et al [ 20 ] Patient 1: female, 51 years old Patient 2: Male, 50 years old Patient 3: Male, 72 years old Patient 4: Male, 73 years old 1: vitrectomy, sulcus IOL, previous uncomplicated ozurdex 2: vitrectomy, posterior iris claw IOL, previous uncomplicated ozurdex 3: vitrectomy with membrane peel, PC-IOL, YAG capsulotomy, multiple previous ozurdex implants 4: vitrectomy, sulcus IOL, previous uncomplicated ozurdex implant 1: corneal edema, Descemet’s membrane folds 2: corneal edema 3: corneal edema 4: corneal edema 1: surgical repositioning using paracentesis and Sinskey hook 2: surgical repositioning using paracentesis and Sinskey hook 3: surgical removal via an 18-gauge needle and Sinskey hook 4: two surgical re-positionings and then eventuall...…”

“…In terms of management of the anterior migration of Ozurdex, several options exist and depend on the surgeon’s preference, presence of corneal damage and history of previous migrations after repositioning the implant [ 9 , 19 , 20 ].…”

“…The non-operative technique involves application of a mydriatic agent followed by posturing and positioning the patient’s globe in such a way that the implant becomes dislodged from the anterior chamber and with the help of gravity re-migrates back into the vitreous chamber. This technique may be aided with corneal manipulation using a cotton tip applicator or ocular massage [ 11 , 15 , 19 , 21 , 25 ]. On the other hand, the operative methods to reposition the implant can vary.…”

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

“…This finding led the authors to conclude that a lens capsule defect or a history of PPV increases the chance of AC migration. Pseudophakia, 6–10 including posterior chamber intraocular lenses (PCIOL), anterior chamber intraocular lenses (ACIOL), 11,12 sulcus intraocular lenses, iris-fixated lenses, 5–7,13,14 scleral-fixated lenses, 12,15–19 and glued IOLs, 20 have all been reported in cases of implant migration. Aphakia, 5,21–26 prior iridectomies, 6,12,20,26,27 congenital iris coloboma, 10 posterior capsule violation during prior surgeries or following posterior capsulotomies, 5,7,13,27 and weak zonules 9,28 are other features frequently noted in these cases.…”

“…Less invasive approaches involve dilating the pupil followed by globe massage in the supine position to allow the implant to fall posteriorly. 1,16,18,32,33 Some advocate using a needle under guidance of the slit lamp to gently push the implant posteriorly. 14 Others support using YAG laser to manipulate the implant.…”