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The clinical outcomes of surgical management of anterior chamber migration of a dexamethasone implant (Ozurdex®)

Authors
 Hyunseung Kang  ;  Min Woo Lee  ;  Suk Ho Byeon  ;  Hyoung Jun Koh  ;  Sung Chul Lee  ;  Min Kim 
Citation
 Graefes Archive for Clinical and Experimental Ophthalmology, Vol.255(9) : 1819-1825, 2017 
Journal Title
 Graefes Archive for Clinical and Experimental Ophthalmology 
ISSN
 0721-832X 
Issue Date
2017
MeSH
Aged ; Anterior Chamber ; Corneal Edema/diagnosis ; Corneal Edema/etiology ; Corneal Edema/surgery ; Dexamethasone/administration & dosage* ; Dexamethasone/adverse effects ; Drug Implants ; Female ; Follow-Up Studies ; Foreign-Body Migration/diagnosis ; Foreign-Body Migration/etiology ; Foreign-Body Migration/surgery ; Glucocorticoids/administration & dosage ; Glucocorticoids/adverse effects ; Humans ; Intravitreal Injections ; Lens Subluxation/diagnosis ; Lens Subluxation/etiology ; Lens Subluxation/surgery ; Macular Edema/diagnosis ; Macular Edema/drug therapy* ; Male ; Middle Aged ; Ophthalmologic Surgical Procedures/methods ; Prognosis ; Retrospective Studies ; Slit Lamp Microscopy ; Tomography, Optical Coherence ; Treatment Failure ; Vitrectomy*
Keywords
Anterior chamber ; Dexamethasone implant ; Dislocation ; Migration ; Ozurdex® ; Vitrectomy
Abstract
PURPOSE: Our purpose was to describe the clinical course, and individualized management approaches, of patients with migration of a dexamethasone implant into the anterior chamber. METHODS: This was a retrospective review of four patients with seven episodes of anterior chamber migration of a dexamethasone implant. 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 had a posterior chamber intraocular lens in the capsular bag but in a post-laser posterior capsulotomy state, two eyes had a sulcus intraocular lens (IOL), and one eye had 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 to 6 weeks. Of the four eyes with corneal edema, 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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161275
DOI
10.1007/s00417-017-3705-y
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실)
Yonsei Authors
강현승(Kang, Hyunseung) ; 고형준(Koh, Hyoung Jun) ; 김민(Kim, Min) ; 변석호(Byeon, Suk Ho) ; 이성철(Lee, Sung Chul)
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Full Text
https://link.springer.com/article/10.1007%2Fs00417-017-3705-y
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