The clinical outcomes of surgical management of anterior chamber migration of a dexamethasone implant (Ozurdex®)

Kang, Hee-Taik; Lee, Min Woo; Byeon, Suk Ho; Koh, Hyoung Jun; Lee, Sung Chul; Kim, Min

doi:10.1007/s00417-017-3705-y

Cited by 28 publications

(23 citation statements)

References 20 publications

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“…In a retrospective review of 924 DEX implantations performed, Kang et al reported four cases of anterior chamber migration in the presence of a compromised posterior capsule, [10] as we observed. In another previous report, corneal oedema was observed when anterior migration occurred over 3 weeks after implant.…”

Section: Discussionsupporting

confidence: 75%

Surgical Management of Complications after Dexamethasone Implant

Sborgia

Niro

D’Oria

et al. 2020

Case Reports in Ophthalmological Medicine

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Purpose. To report surgical management of ocular complications occurred after dexamethasone (DEX) implant (Ozurdex®) injection. Methods. Retrospective interventional case series. Results. Different surgical procedures including viscoexpression to manage the migration of the implant into the anterior chamber, “phaco-rolling” technique for the intralenticular injection, and vitrectomy with implant removal for an acute endophthalmitis were performed. Successful management of different complications after DEX implant by using individualized surgical approaches was observed. Conclusions. Early and targeted surgical management is required in selected cases of ocular complications after DEX implant. The implant removal was needed to preserve ocular anatomy and function.

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Section: Discussionsupporting

confidence: 75%

Surgical Management of Complications after Dexamethasone Implant

Sborgia

Niro

D’Oria

et al. 2020

Case Reports in Ophthalmological Medicine

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“…Several previous publications mention the migration of a dexamethasone implant as an adverse effect of treatment with the Ozurdex implants, but most authors detail the techniques on how to push the implant back into the vitreous cavity by flipping it through the pupil or iridotomy [1,2]. This is, however, not without risks, since the probability of the dexamethasone implant migrating back into the anterior chamber is very high.…”

Section: Resultsmentioning

confidence: 99%

“…It remains in the vitreous cavity for up to 3 months during which it disintegrates, exuding a daily dose of drug until it completely dissolves. The treatment is very efficient, however, in very rare cases, the implant can migrate during these 3 months into the anterior chamber, either through the pupil in aphakia, through fragile lens zonules, or through an iridotomy [1]. Given the confined anatomical situation in the anterior chamber, the implant will mechanically irritate the corneal endothelium and corneal oedema and opacity will result [2].…”

Section: Management Of Anterior Chamber Dislocation Of a Dexamethasonmentioning

confidence: 99%

Management of Anterior Chamber Dislocation of a Dexamethasone Implant

Nguyen

Wolfensberger

2019

Klin Monatsbl Augenheilkd

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Purpose To characterise the surgical removal technique of a dislocated dexamethasone implant in the anterior chamber and to gauge its success by analysing corneal transparency and subsequent visual acuity recovery in the postoperative phase. Methods Description of a patient who presented with an anterior chamber dexamethasone implant migration through an inferior iridotomy performed previously for a silicone oil fill in aphakia. Visual acuity had dropped to counting fingers due to marked corneal oedema. Results The implant was removed using a 23-g needle aligned with the axis of the implant through a paracentesis. After the clinical follow-up at 2 months, best-corrected visual acuity had returned to 0.2, which remained stable at the last follow-up at 14 months with an intraocular pressure of 10 mmHg. The corneal oedema resolved completely. Conclusion This novel surgical management of a dexamethasone implant dislocation into the anterior chamber was successful and resulted in no long-term corneal damage when the implant was removed without delay. A repeated Ozurdex injection in patients with previous inferior iridotomy may require prior suturing of the iridotomy.

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“…In addition, different risk factors for anterior chamber migration have described in a few reports. Some studies have reported that, in aphakic vitrectomized eyes, the implant can maneuver through a pupil, through an iridectomy, and around an IOL to enter the anterior chamber [8,10,15,16]. All of those cases had common histories of a vitrectomy and either weak zonules, a defect, or a missing posterior capsular membrane.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the risk of cataract formation and steroid-induced glaucoma, migration of the dexamethasone implant into the anterior chamber is another possibly severe complication [6,7]. The anterior chamber dislocation of a dexamethasone implant has recently been described in a few reports [8][9][10][11][12]. When migration into the anterior chamber occurs, the patient is at risk for corneal endothelial damage and corneal edema or decompensation.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for and Management of Anterior Chamber Intravitreal Dexamethasone Implant Migration

Röck

Bartz‐Schmidt

Röck

2019

Preprint

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Background This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). Methods A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. Results Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). Conclusions The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.

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The clinical outcomes of surgical management of anterior chamber migration of a dexamethasone implant (Ozurdex®)

Cited by 28 publications

References 20 publications

Surgical Management of Complications after Dexamethasone Implant

Surgical Management of Complications after Dexamethasone Implant

Management of Anterior Chamber Dislocation of a Dexamethasone Implant

Risk Factors for and Management of Anterior Chamber Intravitreal Dexamethasone Implant Migration

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