The Clinical Outcomes of Surgical Management of Anterior Chamber Migration of a Dexamethasone Implant (Ozurdex^®)

Abstract

Purpose : To describe the clinical course, and individualised management approaches of patients with migration of a dexamethasone implant into the anterior chamber.

Methods : A retrospective review of 924 cases of patients who received intravitreal dexamethasone injections.

Results : After 924 intravitreal dexamethasone injections, anterior migration of the implant occurred in four eyes of four patients (0.43%). All four eyes were pseudophakic: one eye with a posterior chamber intraocular lens in the capsular bag but in a post-laser posterior capsulotomy state, two eyes with a sulcus intraocular lens (IOL), and one eye with an iris-fixated retropupillary IOL. All eyes had a prior vitrectomy and no lens capsule. The time interval from injection to detection of the implant migration ranged from 2–6 weeks. Of the four eyes with corneal oedema, only one eye required a corneal transplantation, although it was unclear whether the implant migration was the direct cause of the corneal decompensation because the patient had a history of bullous keratopathy resulting from an extended history of uveitis. All patients underwent surgical intervention: two patients with a repositioning procedure, and the other two patients with removal due to repeated episodes, although surgical removal was not always necessary to reverse the corneal complications.

Conclusions : In our study, not all patients required surgical removal of the implants. Repositioning the implant back into the vitreous cavity may be considered as an option in cases involving the first episode with no significant corneal endothelial decompensation. Considering potential anterior segment complications and the loss of drug effectiveness together, an individualized approach is recommended to obtain the best treatment outcomes and to minimize the risk of corneal complications.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.