Abstract
Purpose:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 746 uveitis-clinical/animal model •
688 retina