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Case Reports
. 2020 Apr 29;50(2):115-122.
doi: 10.4274/tjo.galenos.2019.43778.

Anterior Chamber Migration of Ozurdex Implants

Özcan Kayıkcıoğlu  1 , Suzan Doğruya  2 , Cansu Sarıgül  1 , Hüseyin Mayalı  1 , Emin Kurt  1
Affiliations
Case Reports

Anterior Chamber Migration of Ozurdex Implants

Özcan Kayıkcıoğlu et al. Turk J Ophthalmol. .

Abstract

We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases was vitrectomized eyes. Four of the patients had sutured intraocular lens (IOL) implantation due to complicated cataract surgery, one had combined retinal detachment surgery with sutured IOL implantation, and one had vitrectomy for diabetic intravitreal hemorrhage cleaning and uncomplicated cataract surgery. Anterior chamber implant migration caused corneal edema in all cases and elevated intraocular pressure in three cases. In two cases, the dexamethasone implant was directed into the vitreous cavity after maximum pupillary dilation and corneal manipulation with cotton tip applicator with the patient in reverse Trendelenburg position. There was no other complication until dexamethasone implant degradation, with clear cornea at final examination. In two cases, the implant was removed from the anterior chamber by aspiration, but keratoplasty surgery was planned due to endothelial cell loss and persistent corneal edema during follow-up. In the last two cases, the dexamethasone implant was redirected into the vitreous chamber with a 23-gauge catheter and anterior chamber maintainer but they migrated into the anterior chamber again. In one of these patients, the implant was aspirated by catheter and corneal transplantation was performed due to corneal edema, while the other patient's implant was redirected into the vitreous chamber with no further anterior migration. The risk of dexamethasone implants migrating into the anterior chamber of vitrectomized eyes and those with sutured IOL implantation should be kept in mind and the patient should be informed and advised to see an ophthalmologist immediately before permanent corneal endothelial damage occurs.

Keywords: Dexamethasone implant; corneal edema; pars plana vitrectomy; phacoemulsification.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Follow-up OCT shows cystoid macular edema in a patient who underwent PPV with silicone oil injection due to left retinal detachment (Case 1) OCT: Optical coherence tomography, PPV: Pars plana vitrectomy
Figure 2
Figure 2
Two implants are observed in the anterior chamber of a patient who was given a dexamethasone implant due to post-vitrectomy macular edema and did not regularly attend follow-up visits (Case 1)
Figure 3
Figure 3
Follow-up specular microscopy reveals a decrease in corneal endothelial cell number after the removal of two dexamethasone implants from the anterior chamber (Case 1)
Figure 4
Figure 4
A dexamethasone implant given to treat macular edema in a patient who underwent PPV with sutured IOL implantation after cataract surgery is detected in the anterior chamber (Case 2) PPV: Pars plana vitrectomy, IOL: Intraocular lens
Figure 5
Figure 5
A dexamethasone implant given to treat macular edema in a patient with intravitreal hemorrhage due to proliferative diabetic retinopathy who underwent PPV and endolaser therapy is seen in the anterior chamber (Case 3) PPV: Pars plana vitrectomy
Figure 6
Figure 6
OCT shows persistent macular edema in a patient given dexamethasone implants to treat macular edema due to proliferative diabetic retinopathy (Case 3) OCT: Optical coherence tomography
Figure 7
Figure 7
Anterior chamber migration of the implant was observed at follow-up in a patient who received a third dexamethasone implant due to macular edema (Case 3)
Figure 8
Figure 8
A dexamethasone implant given to treat macular edema in a patient who underwent PPV with sutured IOL implantation after complicated cataract surgery is observed in the anterior chamber (Case 4) PPV: Pars plana vitrectomy, IOL: Intraocular lens
Figure 9
Figure 9
Clear cornea is observed at follow-up after guiding the dexamethasone implant from the anterior chamber back into the vitreous cavity (Case 4)
Figure 10
Figure 10
A dexamethasone implant given to treat macular edema in a patient who underwent PPV with scleral-fixated IOL implantation due to traumatic cataract is seen in the anterior chamber (Case 5) PPV: Pars plana vitrectomy, IOL: Intraocular lens
Figure 11
Figure 11
The dexamethasone implant migrated to the anterior chamber again the day after being repositioned in the vitreous cavity using 23-gauge catheter (Case 5)
Figure 12
Figure 12
Bullous keratopathy is observed at follow-up after the dexamethasone implant that migrated to the anterior chamber twice was removed with a 23-gauge catheter (Case 5)
Figure 13
Figure 13
Anterior chamber migration of a dexamethasone implant given to treat macular edema is observed in a patient who underwent pars plana vitrectomy and scleral-fixated IOL implantation (Case 6) IOL: Intraocular lens
See this image and copyright information in PMC

References

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