A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

Byung Jae Kim; Seong Jae Kim; Yong Seop Han; Seong Wook Seo; Jong Moon Park; Ji Myong Yoo; In Young Chung

doi:10.3341/jkos.2016.57.4.667

Journal List > J Korean Ophthalmol Soc > v.57(4) > 1010569

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Kim, Kim, Han, Seo, Park, Yoo, and Chung: A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

Case Report

J Korean Ophthalmol Soc 2016;57(4):667-671.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.4.667

A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

Byung Jae Kim, MD¹, Seong Jae Kim, MD, PhD^1,², Yong Seop Han, MD, PhD^1,², Seong Wook Seo, MD, PhD^1,², Jong Moon Park, MD, PhD^1,², Ji Myong Yoo, MD, PhD^1,², In Young Chung, MD, PhD^1,^2,

¹Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to In Young Chung, MD, PhD Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea Tel: 82-55-750-8171, Fax: 82-55-758-4158 E-mail: in0chung@hanmail.net

Received 27 February 2015 Revised 10 September 2015 Accepted 30 December 2015

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

To report a case of fragmentation and anterior migration occurred after dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in a branch retinal vein occlusion patient.

Case summary

A 66-year-old male was referred for blurred vision. He received cataract surgery in 1986 and was diagnosed with central retinal vein obstruction in 2011 in the right eye. For treatment of macular edema, dexamethasone intravitreal implant was performed in the right eye. One week after implantation, a fragment of the dexamethasone implant migrated to the anterior chamber with corneal edema and surgical removal was performed immediately. One day after removal, the remaining fragmented implant migrated to the anterior chamber and corneal edema still existed. The fragmented implant was removed with anterior chamber irrigation. After removal, corneal edema improved and visual acuity was recovered.

Conclusions

Anterior migrated dexamethasone implant could induce corneal complications, such as corneal edema and corneal decompensation and might lower the corneal endothelial cell even if immediately removed. We report a case of corneal edema, which was induced by anterior migration of a fragmented dexamethasone implant and recovered with immediate surgical removal.

Keywords: Anterior chamber migration, Corneal edema, Dexamethasone intravitreal implant, Fragmentation, Ozurdex®

References

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Figure 1.

Fundus photography, optical coherence tomography and fluorescent angiography images in an eye with central retinal vein occlusion. (A) A fundus photography showing tortuosity and dilatation of all branches of the central retinal vein, flame-shaped hemorrhages, optic disc and macular edema before implantation. (B) Optical coherence tomography showing macular edema before implantation. (C-H) Fluorescent angiography images showing retinal hemorrhage and leaking before implantation.

Figure 2.

Slit lamp photograph, pachymeter and confocal microscope of one week after intravitreal dexamethasone implantation. Slit lamp photograph shows the fragmented dexamethasone implant in the anterior chamber (A), corneal edema is noted on pachymeter (B) and confocal microscope (C).

Figure 3.

Another fragmented dexamethasone implant migrated to the anterior chamber.

Figure 4.

Slit lamp photograph and confocal microscope of one week after removal of intravitreal dexamethasone implantation. Slit lamp photograph shows the clear cornea (A), corneal thickness was normalized (B), but corneal endothelial cell count was decreased (C).

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