Incomplete scleral penetration of dexamethasone (Ozurdex) intravitreal implant

Sherman, Thomas; Raman, Vasant

doi:10.1136/bcr-2018-227055

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…There have been a few case reports of a dexamethasone intravitreal implant attaching to the macula or penetrating the sclera and inadvertent intralenticular administration . To our knowledge, however, this is the first case of dexamethasone intravitreal implant penetration of the retina and choroid.…”

mentioning

confidence: 80%

Peripapillary Retinal and Choroidal Penetration of a Dexamethasone Intravitreal Implant

Kim

Woo

2021

JAMA Ophthalmol

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A 52-year-old man presented with recurrent macular edema in his left eye, which had been vitrecomized, and he was treated with a dexamethasone intravitreal implant (Ozurdex [Allergan Inc]). The implant was injected via the second-generation applicator while squeezing the button gently. We noticed that the implant had penetrated the retina and choroid nasal to the optic disc 1 month postinjection. During follow-up for 12 months postinjection, the implant penetration was still detected (Figure ), but there were no complications associated with implant penetration.There have been a few case reports of a dexamethasone intravitreal implant attaching to the macula 1,2 or penetrating the sclera 3 and inadvertent intralenticular administration. 4 To our knowledge, however, this is the first case of dexamethasone intravitreal implant penetration of the retina and choroid. Clinicians should be aware of the possibility of chorioretinal penetration when injecting dexamethasone intravitreal implants and should use the proper injection technique, 5 considering the initial muzzle velocity during the application. 6

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confidence: 80%

Peripapillary Retinal and Choroidal Penetration of a Dexamethasone Intravitreal Implant

Kim

Woo

2021

JAMA Ophthalmol

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“…We did not encounter any case of hypotony and its sequelae like choroidal effusion/haemorrhage. There was one case of incomplete penetration [9] of the implant, but that resolved on conservative management without any adverse effect.…”

Section: Complicationsmentioning

confidence: 98%

Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

Raman

Triggol

Cudrnak

et al. 2020

Eye

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Purpose To assess the safety of nurse-led services of intravitreal injection of dexamethasone implant. Methods An audit of intravitreal injection of dexamethasone implant service in our unit revealed a significant delay in the delivery of injection from the time a clinical decision was made. The limiting factors were an inadequate number of injectors and limited capacity. The constraint in capacity was addressed by moving the service from the theatre to the cleanroom in the outpatients setting. Two senior nurse practitioners in the existing pool of injectors, experienced in intravitreal anti-VEGF injection, were trained to deliver the intravitreal dexamethasone implant service. A safety audit was carried out after they had completed 1000 cases. Results The nurse practitioners administered 1006 injections from February 2017 to October 2019. There was no case of endophthalmitis (0%) or other visually significant complications like retinal detachment, vitreous haemorrhage, hypotony or iatrogenic cataract. One patient had incomplete scleral penetration of the implant, but this resolved without any sequelae. The waiting time to inject the implant nearly halved from 29.5 to 15 days in the nurse-led service. A patient satisfaction survey was overwhelmingly positive, with the majority advocating for the continuation of the nurse-led service. Conclusion The current cohort of experienced nurses providing anti-VEGF injections can be trained under supervision to inject the intravitreal dexamethasone implant (Ozurdex). This is safe, additionally effective in streamlining the service and reducing the waiting time for delivery of the steroid implant.

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“…Interestingly, sporadic errors in the intravitreal injection technique led to incomplete penetration of the device in the vitreous cavity. Although this complication should be avoided at any cost, the devices reabsorbed in a couple of months [173].…”

Section: Dex Implant and Anterior Segment Complicationsmentioning

confidence: 99%

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

et al. 2020

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Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

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Incomplete scleral penetration of dexamethasone (Ozurdex) intravitreal implant

Cited by 5 publications

References 5 publications

Peripapillary Retinal and Choroidal Penetration of a Dexamethasone Intravitreal Implant

Peripapillary Retinal and Choroidal Penetration of a Dexamethasone Intravitreal Implant

Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

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