Incomplete scleral penetration of dexamethasone (Ozurdex) intravitreal implant

Abstract

Ozurdex (Allergan, Irvine, California, USA) is a biodegradable sustained release intravitreal implant containing 0.7 mg dexamethasone in a solid polymer drug delivery system. In the UK, it is approved for use in patients with macular oedema secondary to retinal vein occlusion, diabetic maculopathy and non-infectious uveitis. Although the implant is meant to be injected into the vitreous cavity, it can be inadvertently injected into the crystalline lens. This can also migrate into the anterior chamber, under altered anatomical conditions of the anterior segment. We report a case of incompletely penetrated dexamethasone implant, in a patient undergoing treatment for macular oedema secondary to retinal vein occlusion. The partially penetrated implant was managed conservatively with a good outcome.

Keywords: macula; retina.

Figure 1

Localised conjunctival hyperaemia over protruding Ozurdex implant.

Figure 2

At higher magnification, the intact conjunctiva is demonstrable over the protrusion.

Figure 3

Ultra-widefield photography (Optos) confirms the presence of Ozurdex implant, corresponding to injection site superotemporally.

Figure 4

Two months postinjection showing resolution of conjunctival inflammation and disappearance of the incompletely penetrated implant. Note multiple grey scars in the sclera from previous injection.