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Sujit Itty, Joseph Martel, Glenn Jaffe; Spontaneous Dislocation of the Pellet from the Strut in the Fluocinolone Acetonide Sustained Release Implant (Retisert®). Invest. Ophthalmol. Vis. Sci. 2013;54(15):2946.
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To characterize the spontaneous dissociation of the pellet from the strut of the Fluocinolone Acetonide Sustained Release Implant (Retisert; Bausch and Lomb), describe a bimanual technique for pellet removal, and report clinical outcomes.
The medical records of 74 Retisert implantations in 47 patients by a single surgeon between 1998 and 2012 were reviewed for evidence of posterior segment pellet dislocation, either in the clinic or at the time of implant replacement.
Four (5.4%) of 74 implants had spontaneous pellet dislocations identified on preoperative examination at a mean of 71.1 months (range 41-127 months) after implantation, with a mean follow up of 42 months (range 1- 126 months). All pellets were removed using a bimanual technique utilizing an infusion chandelier and a silicone soft-tip aspiration cannula to safety engage the implant on the surface of the retina and elevate it to the mid-vitreous cavity where it could be grasped with diamond-dusted foreign body forceps and removed through an enlarged scleral wound. No posterior segment complications occurred, and vision returned to pre-operative levels or better in all four patients at 3 months. Of the 30 Retisert implants that were exchanged in this series, an additional eight (26.7%) pellets were identified to be separated from the strut at the time of implant removal and not during preoperative exams.
Pellet separation from the strut can spontaneously occur in Retisert implants usually as a late complication after 3 years. Removal of the dislocated pellet can be achieved safely without a significant decline in vision. Dislocated pellets may also not be significantly dislodged from the strut and may only be diagnosed at the time of surgical replacement.
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