Surgical Management of Anterior Chamber Migration of a Dexamethasone Intravitreal Implant

Abstract

Background and objective: Anterior chamber migration of the dexamethasone intravitreal implant (Ozurdex; Allergan, Irvine, CA) may lead to corneal edema and elevated intraocular pressure, warranting removal of the implant.

Materials and methods: A 59-year-old patient with a history of prior vitrectomy, a posterior chamber intraocular lens with a disrupted posterior capsule, and a large inferior peripheral iridectomy presented with decreased vision due to corneal edema following dexamethasone intravitreal implant injection. The authors describe their technique for implant removal, which uses standard vitreoretinal instrumentation, viscoelastic, a modified Sheets glide, and angled forceps in order to avoid fragmentation of the implant and limit iatrogenic morbidity.

Results: The implant was successfully explanted. Postoperatively, the patient experienced improvement in the corneal edema, and after Descemet's stripping endothelial keratoplasty achieved a final best corrected visual acuity of 20/60 at final 12-month follow-up.

Conclusion: Patients with aphakic lens status, anterior chamber intraocular lens with a disrupted posterior capsule, posterior chamber intraocular lens and a ruptured capsule, prior vitrectomy, and large peripheral iridectomies may be susceptible to migration of dexamethasone intravitreal implants into the anterior chamber.