Dexamethasone Implant Removal From Anterior Chamber: Surgical Technique

Ruiz-Casas, D.; Gros-Otero, Juan; Casado, Alfonso

doi:10.1097/icb.0000000000000335

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…× 3 PPV Not mentioned surgical removal: corneal incision and reorientation of implant perpendicular to incision. Then viscoelastic injection distal to implant- implant which caused egression Ruiz-Casas et al [ 28 ]c Male, 64 years old Dislocated lens extracted, vitrectomy, anterior chamber IOL Corneal edema Surgical removal, using a lens injector to capture and remove Ozurdex Vela et al [ 29 ] Female, 65 years old Multiple retinal detachment surgeries, iris-claw IOL No corneal edema Surgical repositioning of implant to VC using 30 g needle. No viscoelastic used Röck et al [ 6 ] Patient 1: Female, 47 years old Patient 2: Male, 76 years old Patient 3: Female, 84 years old Patient 4: Female, 69 years old 1: Noninfectious chronic uveitis, vitrectomy, previous dislocated IOL, scleral fixation IOL 2: pseudoexfoliation syndrome, previous dislocated IOL, vitrectomy, scleral fixation IOL, Irvine-Gass syndrome 3: vitrectomy and scleral fixation IOL, Irvine-Gass syndrome 4: noninfectious chronic uveitis, posterior chamber IOL, partial zonular dehiscence so then vitrectomy and surgical posterior capsulotomy done 1: Corneal edema 2: Corneal decompensation with bullous keratopathy 3: Corneal edema, bullous keratopathy 4: Corneal edema, Descemet’s folds 1: Surgical removal via paracentesis with viscoelastic injection and use of 20 g alligator forceps 2: Surgical removal via paracentesis with viscoelastic injection and use of 20 g alligator forceps 3: DMEK 4: surgical removal Bansal et al [ 30 ] Patient 1: Male, 47 years old Patient 2: Male, 13 years old Patient 3: Male, 15 years old 1: chronic anterior uveitis, post-lensectomy-vitrectomy, aphakia 2: Bechet’s syndrome, post-lensectomy-vitrectomy, aphakia 3: Chronic anterior uveitis, post-lensectomy and vitrectomy, aphakia 1: Corneal edema, Descemet’s folds 2: Corneal edema, elevation of IOP 3: No complications 1: remigrated to vitreous cavity on its own 2: surgical removal 3: remigrated back to vitreous upon supine position Khurana et al [ 31 ] Patient 1: Male, 65 years old Patient 2: Female, 49 years old Patient 3: Male, 61 years old 1: ...…”

Section: Resultsmentioning

confidence: 99%

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management

Tsoutsanis,

Kapantais

2023

Int J Retin Vitr

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Purpose To describe the common risk factors, complications, and management options for anterior migration of Ozurdex implant. Methods A comprehensive review of the literature was performed. Results Amongst the most common risk factors predisposing to implant anterior migration we found a history of pseudophakia or aphakia or previous vitrectomy. The most common complication is that of corneal edema. Conclusions A variety of management options to treat migration of the dexamethasone implant are utilized by different specialists around the world. These depend on the doctor’s preference, presence of corneal damage and history of previous migrations after repositioning the implant. The most common approaches are operative or non-operative implant repositioning and surgical implant removal.

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Section: Resultsmentioning

confidence: 99%

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management

Tsoutsanis,

Kapantais

2023

Int J Retin Vitr

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“…A repeated Ozurdex injection in patients with previous inferior iridotomy is possible but may require prior suturing of the iridotomy to avoid a repeat migration. Other authors have suggested the use of a lens injector cartridge or vitrectomy instruments and forceps to withdraw the implant from the anterior chamber [3,4]. Although these techniques are successful, the additional costly material to achieve the result may not be necessary.…”

Section: Resultsmentioning

confidence: 99%

Management of Anterior Chamber Dislocation of a Dexamethasone Implant

Nguyen

Wolfensberger

2019

Klin Monatsbl Augenheilkd

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Purpose To characterise the surgical removal technique of a dislocated dexamethasone implant in the anterior chamber and to gauge its success by analysing corneal transparency and subsequent visual acuity recovery in the postoperative phase. Methods Description of a patient who presented with an anterior chamber dexamethasone implant migration through an inferior iridotomy performed previously for a silicone oil fill in aphakia. Visual acuity had dropped to counting fingers due to marked corneal oedema. Results The implant was removed using a 23-g needle aligned with the axis of the implant through a paracentesis. After the clinical follow-up at 2 months, best-corrected visual acuity had returned to 0.2, which remained stable at the last follow-up at 14 months with an intraocular pressure of 10 mmHg. The corneal oedema resolved completely. Conclusion This novel surgical management of a dexamethasone implant dislocation into the anterior chamber was successful and resulted in no long-term corneal damage when the implant was removed without delay. A repeated Ozurdex injection in patients with previous inferior iridotomy may require prior suturing of the iridotomy.

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“…One may also aspirate the implant into the needle lumen which can also reduce the risk of implant breakage within the eye. 34 A surgical approach, described by Ruiz-casas et al, 35 involves filling the AC with viscoelastic, inserting a viscoelastic-filled lens injector cartridge through a 2.2–2.7 mm corneal incision and using a viscoelastic cannula or lens rotator to gently push the DEX implant into the lens injector and out of the eye. Another method by Lee et al describes introducing a Sinksy hook into the AC through a paracentesis incision to push the implant to the periphery, under the iris and behind the IOL.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone implant migration in an eye with congenital glaucoma: A case report and review of the literature

Chang

Peter

et al. 2021

European Journal of Ophthalmology

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Introduction: The dexamethasone (DEX) implant is an FDA approved treatment for diabetic macular edema, non-infectious posterior uveitis, and macular edema secondary to branch or central retinal vein occlusions. We describe a case of anterior chamber (AC) migration of a DEX implant in a patient with a history of congenital glaucoma and perform a review of the literature on this particular complication, summarizing the common risk factors, subsequent complications, and management options. Case description: A 46-year-old female with a history of congenital glaucoma, status post cataract extraction with insertion of intraocular lens, pars plana vitrectomy, and Baerveldt tube implant in the left eye was referred for post-operative cystoid macular edema (CME). The patient underwent insertion of a DEX implant, resulting in improvement in her CME. After the fourth implant was injected, the patient noticed a white line in her eye while looking in the mirror after doing jumping jacks. Slit lamp examination confirmed migration of the implant into the AC. Ultimately, the patient was taken to the operating room, where her implant was removed via bimanual vitrectomy through an anterior approach. Conclusion: This case report and literature review explores the ophthalmic structural changes specific to congenital glaucoma which may have predisposed this eye to anterior migration of the DEX implant. The purpose of this review is to detail the anatomic changes that may increase the risk of anterior chamber implant migration in patients with congenital glaucoma so that physicians may be aware of these risks when selecting patients for this implant.

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Dexamethasone Implant Removal From Anterior Chamber: Surgical Technique

Cited by 9 publications

References 9 publications

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management

Anterior migration of Ozurdex implant: a review on risk factors, complications, and management

Management of Anterior Chamber Dislocation of a Dexamethasone Implant

Dexamethasone implant migration in an eye with congenital glaucoma: A case report and review of the literature

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