A Case of Dexamethasone Intravitreal Implant Fragmentation During the Injection Procedure in Central Retinal Vein Occlusion

Sang Moon Youn; Sung Jin Park; Ho Young Lee; Sung Hyup Lim; Il Han Yun

doi:10.3341/jkos.2013.54.6.982

Journal List > J Korean Ophthalmol Soc > v.54(6) > 1009717

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Youn, Park, Lee, Lim, and Yun: A Case of Dexamethasone Intravitreal Implant Fragmentation During the Injection Procedure in Central Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2013;54(6):982-986.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.6.982

A Case of Dexamethasone Intravitreal Implant Fragmentation During the Injection Procedure in Central Retinal Vein Occlusion

Sang Moon Youn, MD^1,², Sung Jin Park, MD^1,², Ho Young Lee, MD^1,^2,, Sung Hyup Lim, MD^1,², Il Han Yun, MD, PhD¹

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Therapeutics Center for Ocular Neovascular Disease, Busan, Korea

Address reprint requests to Ho Young Lee, MD Department of Ophthalmology, Inje University Busan Paik Hospital #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6016, Fax: 82-51-890-6329, E-mail: happytriad@gmail.com

Received 8 December 20123 January 2013 Accepted 23 March 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of dexamethasone intravitreal implant (Ozurdex^®; Allergan, Inc.) fragmentation during the in-jection procedure in macular edema due to central retinal vein occlusion.

Case summary

A 57-year-old man visited our hospital for visual disturbance in his right eye. The patient’s best-corrected visual acuity was 0.02 in the right eye and 1.2 in the left eye. After fundus examination, the patient was diagnosed with cen-tral retinal vein occlusion with macular edema, thus bevacizumab was injected in the right eye. However, the macular ede-ma did not improve, and a dexamethasone intravitreal implant was injected in the right eye. Immediately after the dex-amethasone intravitreal implant injection, on fundus exam, the drug was observed to be fragmented into 3 pieces without any additional treatment. After 2 months, the patient’s best-corrected visual acuity was 0.4 in the right eye and 1.2 in the left eye. Macular edema decreased according to optical coherence tomography.

Conclusions

A case of dexamethasone intravitreal implant fragmentation during an injection procedure has not been pre-viously reported in Korea. Although the drug fragmented, the treatment was effective without complications.

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Keywords: Dexamethasone intravitreal implant, Fragmentation, Ozurdex^®

References

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2. Gan IM, Ugahary LC, van Dissel JT, van Meurs JC. Effect of intra-vitreal dexamethasone on vitreous vancomycin concentrations in patients with suspected postoperative bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2005; 243:1186–9.

3. Pardo-López D, Francés-Muñoz E, Gallego-Pinazo R, Díaz-Llopis M. Anterior chamber migration of dexametasone intravitreal im-plant (Ozurdex^®). Graefes Arch Clin Exp Ophthalmol. 2012; 250:1703–4.

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8. Haller JA, Dugel P, Weinberg DV. . Evaluation of the safety and performance of an applicator for a novel intravitreal dex-amethasone drug delivery system for the treatment of macular edema. Retina. 2009; 29:46–51.

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Figure 1.

Patient’s fundus photographs and optical coherence tomography: (A, B) At initial presentation, fundus revealed flame-shaped retinal hemorrhage, retinal vein engorgement and papilledema. A Severe macular edema is seen on OCT. Patient’s visual acuity was 0.02. (C, D) Two month later, fundus revealed resolving retinal hemorrhage and papilledema. A significant de-crease in macular edema is seen on OCT. Patient’s visual acuity was 0.4.

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Figure 2.

(A) Photographs immediately after dexamethasone intravitreal implant injection shows that drug is fragmented to 3 pieces. Slit lamp photographs using contact ocular lens. The fragmented dexamethasone intravitreal implant is seen in the inferior fundus area. (B) Next day, (C) Two months later.

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