Dexamethasone intravitreal implant migration into the anterior chamber: case series and review of the literature
Authors: Devin Betsch, R. Rishi Gupta.
Author Disclosure Block: D. Betsch: None. R. Gupta: None.
Purpose: Our objective was to report patient demographics, clinical course, and visual outcomes across a case series of patients who experienced Ozurdex® (dexamethasone intravitreal implant) migration into the anterior chamber.
Study Design: Chart review was conducted for patients with a migrated Ozurdex® implant in the anterior chamber. Data collected for each case included, but was not limited to age, indication for Ozurdex® injection, symptoms at the time of migration, duration from detection to treatment, type of intervention performed, and visual acuity before and after implant migration.
Methods: This study was conducted in accordance with the principles outlined in the Declaration of Helenski, and local Research Ethics Board approval was obtained prior to initiation of this project. Data was recorded in a standardized Excel spreadsheet. For numerical responses, means and standard deviations were calculated. Percentages and absolute numbers were used to report the proportion of patients who experienced the various outcomes of interest.
Results: A total of 32 cases of Ozurdex® implant migration into the anterior chamber were included. The mean age was 66.8 years old (SD = 12.5). Twenty-eight patients (87.5%) were male, and 18 (56.3%) cases occurred in the right eye. All 32 cases occured in pseudophakic eyes, and of those, nine (28.1%) had posterior chamber intraocular lenses within the capsular bag with no known capsular or zonular issues. The mean duration from Ozurdex® injection to detection of migration was 19.4 days (SD = 14.5). Twenty-one patients (65.6%) underwent Ozurdex® explantation, and six (18.8%) had their implants repositioned, either in the vitreous cavity or subconjunctival space. Twelve patients (37.5%) ultimately went on to require corneal transplantation, which is consistent with previously published case series on the topic. Thirteen patients (40.6%) had a Snellen visual acuity of 20/200 or less at their most recent follow up.
Conclusions: When compared to published literature on the topic, this is the largest case series of Ozurdex® implant migration into the anterior chamber that has been compiled to date. Interestingly, cases of migration occurred in individuals with no known history of significant prior zonule disruption. This potential complication should be discussed with all patients undergoing Ozurdex® injection, which may aid in earlier presentation and improved visual outcomes.