Introduction:

Intravitreal dexamethasone implants are currently an opti on for chronic macular edema due to diabetes, non-infectious uveitis and retinal vein occlusion. Anterior chamber migration is a rare event, occurring mostly in vitrectomized patients without posterior capsule integrity. This condition is associated with persistent corneal edema and ocular hypertension, therefore requiring intervention. The few cases published suggest first attempting positional maneuvers to relocate the implant, its surgical reinsertion or complete removal.

Clinical Cases:

The authors present the case of a 71-year old man, with the relevant ocular history of a retinal detachment 2 years ago treated with phaco-vitrectomy, presenting with a 4-month-long chronic macular edema. The surgery at that time was notable for an in-the-bag placement of the IOL, with a posterior capsule rupture. Visual acuity (VA) was 8/10 before the onset of the edema, reducing to 5/10 with its progression. An intravitreal injection of a dexamethasone implant was the procedure of choice. 3 weeks after the implant injection, even though a reduction of retinal edema and VA improvement to 7/10 were noted, an anterior migration of the entire implant was diagnosed. At that time, the patient had no corneal edema or increased ocular pressure. Positioning maneuvers were attempted while on ipsilateral lateral decubitus, but unsuccessful and the authors opted for immediate surgery. No obvious capsular breaks or zonular dehiscence areas were found on exploration and the removal of the entire implant was decided. The frailty of the implant made any grasping attempts impossible, requiring the aid of viscoelastic to evacuate the contents from the anterior chamber and a simcoe cannula for aspiration. During the next few weeks, the follow-up had no complications and the cornea remained clear. To this date, after 2 months of follow-up, the macular edema did not recur and VA remained stable at 8/10.

Conclusion:

Anterior migration of Ozurdex® is a possibility in vitrectomized patients. Management of this situation is vital and the diagnosis may be delayed due to the increased follow-up intervals allowed by these injections. Additionally, the frailty of the implant itself makes grasping maneuvers difficult. Positioning and self-check recommendations, as well as a closer follow-up, may be helpful to these patients. Therefore, knowledge of this complication and its management seems mandatory to all ophthalmologists.

Contact Details:

Email: ppnves@gmail.com
Cell Phone: /+351963687458

Pedro Neves