Peripapillary Retinal and Choroidal Penetration of a Dexamethasone Intravitreal Implant

Abstract

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

Two fluocinolone implants adherent to the macula and each other

“… 1 , 2 Recently, a case report was published on how a dexamethasone implant penetrated the retina and choroid with no complications to the patient. 3 There have been no reports of fluocinolone acetonide implants adherent to the macula, much less to each other. The location of the implants in the posterior pole is likely due to gravity (presumed higher specific gravity of the implants compared to vitreous) and the patient's supine positioning during sleep.…”