Adjunctive dexamethasone implant in patients with atopic dermatitis and retinal detachment undergoing vitrectomy and silicone oil tamponade: an interventional case series

Abstract

Background: To report the clinical course and outcomes of adjunctive dexamethasone implants in patients with atopic dermatitis (AD) and retinal detachment (RD) undergoing vitrectomy and silicone oil tamponade.

Methods: This retrospective, interventional case series included AD patients with RD and various degrees of proliferative vitreoretinopathy (PVR) who were scheduled to undergo vitrectomy. Following total vitrectomy and retinopexy, silicone oil tamponade was performed. Finally, an intraocular dexamethasone implant was injected intravitreally. Anatomical and functional outcomes were assessed at 12 months, and extended follow-up data were also collected.

Results: Seven eyes from six patients (five male, one female) were included. The median age was 29 (range, 20-38) years. Preoperatively, six eyes were pseudophakic, two eyes had a history of previous vitreoretinal surgery, and one had uveitis. Postoperatively, best-corrected visual acuity improved in two eyes, worsened in one, and remained similar in four. Retinal attachment was maintained in all eyes at 12 months. The major complication was an increase in postoperative intraocular pressure in six eyes, requiring either medical or surgical treatment. During the extended follow-up period (15-37 months), retinas remained attached in all eyes and stable visual acuity was maintained in five.

Conclusions: Injection of an intraoperative dexamethasone implant to silicone oil-filled eyes appears tolerable and may be beneficial in the surgical management of AD patients with RD and PVR.

Keywords: Atopic dermatitis; Dexamethasone implant; Ozurdex; Proliferative vitreoretinopathy; Retinal detachment; Silicone oil tamponade.

Fig. 1

Pre- and postoperative images of Case 1. a Preoperative wide-angle fundus photograph showing inferotemporal retinal detachment with vitreous opacity. b Fundus at 3 days post-surgery showing attached retina and DEX implant located near the optic disc. c Fundus at 4 weeks post-surgery showing successfully attached retina with silicone oil tamponade. Note that the implant has spontaneously moved to the periphery. d Preoperative optical coherence tomography showing retinal detachment involving the fovea. e Optical coherence tomography obtained at 3 days post-surgery. f Optical coherence tomography obtained at 4 weeks postsurgery

Fig. 2

Pre- and postoperative images of Case 2, who had undergone prior scleral buckle surgery. a Preoperative wide-angle fundus photograph showing recurrent retinal detachment despite previous segmental scleral buckling surgery. b Fundus at 2 weeks post-surgery showing an attached retina and a dexamethasone implant in silicone oil. The photo is blurry because of a corneal epithelial defect. c Preoperative optical coherence tomography image showing retinal detachment involving the fovea. d Optical coherence tomography image obtained at 2 weeks post-surgery. e Wide-angle fundus photograph obtained at 1 year post-surgery. The image is hazy because of herpetic keratitis. f Slit-lamp photograph showing central corneal opacity. g Optical coherence tomography image obtained at 1 year post-surgery. Although the retina was successfully attached, visual acuity failed to improve because of corneal opacity

Fig. 3

Pre- and postoperative images of Case 3 who had undergone multiple prior vitrectomy procedures. a Preoperative wide-angle fundus photograph showing proliferative vitreoretinopathy with silicone oil tamponade. b Postoperative wide-angle fundus photograph showing successful attachment of the retina and DEX implant located in the silicone oil. c Preoperative optical coherence tomography showing retinal thickening and retinal detachment involving the fovea. d Postoperative optical coherence tomography showing the reattached retina