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Vincent Fortoul, Laurent Kodjikian, Philippe Denis; Anterior migration of Dexamethasone intravitreal implants: how to manage with these complications?. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1793.
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To evaluate and describe the risks factors, ocular complications, and the different managements strategies when an anterior migration of dexamethasone (DEX) intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) occurred. We also propose 2 simples’ decision trees to prevent and to manage these complications.
A retrospective study to analyze the main cases (n=15) of anterior migration of DEX intravitreal implant since 2010 until November 2013. The researches have been made with PubMed database. Only articles in English and French were used.
15 cases (15 eyes) of anterior migration of DEX intravitreal implant were reported in PubMed database. The mean age was 55.3 years (SD±21,09). The mean delay when an anterior migration occured was 16.3 days (range:1-40 days). DEX implant was indicated for macular edema after BRVO (13.3%; n=2), CRVO (33%; n=5), Irvine-Gass syndrome (26.7%; n=4), and non-infectious uveitis (26.7%; n=4). 80% (n=12) of eyes were pseudophakic, 20% (n=3) were aphakic. 93.3% (n=14) of the eyes had no posterior lens capsule. A previous pars plana vitrectomy was reported for 73.3% (n=11) of the eyes. 33.3% (n=5) of the patients were supported with simples postural management. Only 1 of these patients required a secondary surgical extraction of the DEX implant, after an early re-migration at 48h. 46.7% (n=7) required a primary surgical extraction, 13.3% (n=2) a surgical integration in the vitreous humor, and 6.7% (n=1) a Nd-YAG Laser fragmentation. Finally, 73.3% (n=11) of the eyes presented an important endothelial corneal decompensation more than 1 month after management of the anterior migration. Among these eyes, 45% (n=5) required a corneal transplantation. No significant differences ((p>0.05) were noted between the two main management strategies (postural or primary surgical) for permanent corneal edema risk.
We defined different risks factors (aphakic or pseudophakic status when there is no posterior lens capsule, in vitrectomized or not vitrectomized eyes) that must be known in clinical practice to prevent an anterior migration of DEX intravitreal implant. Permanent corneal edema is the main complication after anterior migration.
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