Intravitreal Dexamethasone Implant Migration into the Anterior Chamber: A Multicenter Study from the Pan-American Collaborative Retina Study Group

Abstract

Purpose : To establish the prevalence and risk factors for intravitreal dexamethasone implant migration into the anterior chamber in eyes with macular edema and management options.

Methods : This was a multicenter, retrospective, observational study chart review of data collected from patients with macular edema treated with one or more injections of dexamethasone implants 0.7 mg at the vitreoretinal diseases units of 11 Latin American centers. The data collected from the patient charts included age, gender, etiology of the macular edema, history of cataract surgery or vitrectomy, intraocular lens status, number of implants injected, and the complications of the implant migration into the anterior chamber.

Results : Seven hundred sixty-one patients were included, and 1,071 intravitreal injections of the dexamethasone implant were administered. The prevalence of migration in these patients, considering the number of injections, was 1.3%. A total of 293 charts had incomplete data and were excluded from the analysis; of the remaining patients the prevalence of migration, considering the number of injections, was 1.6%. In this subsample, significant associations were seen between implant migration and a history of cataract surgery (P=0.043) and intraocular lens status (P=0.005). The association between implant migration and a history of vitrectomy was marginally significant (P=0.057). The patients with implant migration into the anterior chamber underwent surgical removal of the implant with forceps with or without viscoelastic expression.

Conclusions : The risk of implant migration varies from 1.3% to 1.6%. Risk factors for migration were a history of cataract surgery or vitrectomy and aphakia. When anterior migration occurs, rapid removal is advised, especially if corneal edema is present.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Figure 1.1.A Migration of the dexamethasone implant into the anterior chamber. Figure 1.1.B Ultrasound biomicroscopy image of a patient with migration of the dexamethasone implant. Figure 1.2 Surgical removal of the dexamethasone implant from the anterior chamber using intraocular forceps. Figure 1.3 Surgical removal of the dexamethasone implant from the anterior chamber using intraocular forceps and viscoelastic expression.

 

Table 1. Prevalence of Implant Migration into the Anterior Chamber.