LAUSR.org creates dashboard-style pages of related content for over 1.5 million academic articles. Sign Up to like articles & get recommendations!

Simple technique for management of anterior chamber‐migrated Ozurdex® implant

Photo from wikipedia

Editor, W e would like to introduce a simple technique for management of implant migration to the anterior chamber in patients with ruptured posterior capsules that returns the implant to… Click to show full abstract

Editor, W e would like to introduce a simple technique for management of implant migration to the anterior chamber in patients with ruptured posterior capsules that returns the implant to the posterior chamber without need for removal. Ozurdex (Allergen, Irvine, CA, USA) implant is a sustained-release dexamethasone implant that is used to treat macular oedema. However, occurrences of sideeffects have been reported, such as migration of the Ozurdex implant into the anterior chamber (PardoL opez et al. 2012; Malcl es et al. 2013; Schmitz et al. 2014; Unsal et al. 2017). Ozurdex implant migration requires immediate treatment as it can cause permanent damage to the corneal endothelium. Unfortunately, removal can be difficult because the implant itself can be easily fractured by external forces. We experienced this difficulty in women in her 50’s who presented with anterior chamber migration of Ozurdex implant (Fig. 1A). She had been injected with Ozurdex twice due to cystoid macular oedema and sought medical attention due to decreased visual acuity and ocular pain. Before the procedure, best-corrected visual acuity (BCVA) of the involved eye was 20/100 and intraocular pressure (IOP) was 25 mmHg; the corneal endothelial cell count of the involved eye could not be measured by specular microscopy due to corneal oedema. A sinsky hook was introduced into the anterior chamber through the paracentesis incision site to push the implant to the periphery. The implant must be handled with care to prevent fracturing. Balanced salt solution (BSS) was injected whenever necessary during the procedure to maintain the anterior chamber. First, we placed one side of the implant under the iris at the direction of the incision site, which allows for easier manipulation (Fig. 1B). Then, we pulled on the middle of the implant with the hook to pull the entire implant under the iris and behind the intraocular lens (IOL; Fig. 1C). The implant then was gently pushed with the sinsky hook to reposition the implant back into the vitreous cavity through the ruptured posterior capsule (Fig. 1D). Finally, a miotic agent was inserted to prevent recurrence of anterior chamber migration (Video Clip S1 content). At the end of the procedure, anterior chamber was carefully examined for signs of vitreous prolapse or incarceration, to minimize any potential risk of developing retinal detachment or postoperative infection. At immediate postprocedure followup, the implant was well positioned in the vitreous cavity and anterior chamber migration did not recur. Corneal oedema improved progressively and was resolved at 2 months postprocedure. Best-corrected visual acuity (BCVA) improved to 20/40 and IOP was 14 mmHg, with an 841 cells/mm endothelial cell count. Due to the return of the Ozurdex implant into the vitreous cavity, macular oedema was resolved. In patients with history of cataract surgery or vitrectomy, possible damage to the posterior capsule or aphakic eye status may allow for easier migration of Ozurdex implants due to the lack of a primary physical barrier. In a study by Khurana et al., among 14 patients with migrated implants, corneal oedema remained in 10 (71%) eyes and required corneal transplantation in six (43%) eyes due to severity (Khurana et al. 2014). Therefore, patients must receive warnings of potential risks as well as instructions on how to selfcheck injected eyes in the mirror for

Keywords: anterior chamber; chamber; migration; ozurdex implant

Journal Title: Acta Ophthalmologica
Year Published: 2018

Link to full text (if available)


Share on Social Media:                               Sign Up to like & get
recommendations!

Related content

More Information              News              Social Media              Video              Recommended



                Click one of the above tabs to view related content.