Nonpharmacological Aspects of Intravitreal Dexamethasone Implant Injections

Abstract

Purpose: This study aims to evaluate the non-pharmacological safety profile of intravitreal dexamethasone (DEX) implants in cases with different etiologies. Methods: This retrospective university-based study analyzed clinical reports of patients receiving 0.7 mg DEX implant injections between 2013 and 2023. The study recorded patient demographics, injection indications, and follow-up data. Complications caused by the injection procedure and adverse events other than pharmacological side effects within a 3-month period were included. Results: In this study, 3430 DEX implant injections were made into 1471 eyes of 1091 patients. Non-pharmacological complications developed in 611 injections (17.8%). Subconjunctival hemorrhage was noted as the leading non-pharmacological complication (n=576, 16.8%). Sight-threatening 35 non-pharmacological adverse events and complications (1.0%) were recorded. Cases of anterior chamber migration, vitreous hemorrhage, retinal detachment, endophthalmitis, hypotony, and implant misplacement were observed. Cases requiring intensive treatments and additional surgical interventions were encountered. Conclusion: The injection of the DEX implant may lead to non-pharmacological complications caused by the mechanical impact of the injection or improper positioning of the implant, potentially resulting in vision loss. Severe outcomes such as corneal decompensation, retinal detachment, and endophthalmitis can ensue, emphasizing the gravity of these complications. Careful selection of patients and adherence to proper injection techniques are essential in reducing these risks.