Dexamethasone implant anterior chamber migration: Risk factors, complications, and management strategies

Rahul N. Khurana, Suri N. Appa, Colin A. McCannel, Michael J. Elman, Susan E. Wittenberg, David J. Parks, Saad Ahmad, Steven Yeh

Research output: Contribution to journalArticlepeer-review

120 Scopus citations

Abstract

Objective To describe the risk factors, clinical course, and complications of migration of a dexamethasone (DEX) intravitreal implant (OZURDEX; Allergan, Inc., Irvine, CA) into the anterior chamber and subsequent management strategies. Design Retrospective, observational case series. Participants Fifteen patients had 18 episodes of migration of the DEX implant into the anterior chamber. Methods The medical records of 15 patients with spontaneous migration of a DEX implant were retrospectively reviewed. Main Outcome Measures Migration of the DEX implant into the anterior chamber. Results Migration of a DEX intravitreal implant into the anterior chamber occurred in 6 patients who were aphakic, 4 patients with an anterior chamber intraocular lens, 2 patients with a scleral-fixated posterior chamber intraocular lens (PCIOL), 2 patients with a PCIOL, and 1 patient with an iris-fixated PCIOL. All 15 patients had prior pars plana vitrectomy, and 14 patients (93%) had no lens capsule. The average interval from DEX implant injection to detection of the implant migration into the anterior chamber was 13 days (range, 5-44 days). In 14 patients, corneal edema developed. Among those eyes undergoing surgical removal of the implant, earlier intervention reduced the likelihood of permanent corneal edema (0.5 days [from diagnosis of migration to surgical removal of the implant] vs. 5.5 days; P = 0.04). Aspiration was necessary to remove the implant in 6 patients. Among the 14 patients with corneal edema, the corneal edema did not resolve in 10 patients (71%), 6 (43%) of whom required corneal transplantation. Conclusions Absence of lens capsule and prior vitrectomy are risk factors for migration of the DEX implant into the anterior chamber. Early removal of the implant may be necessary to minimize the risk of chronic corneal edema.

Original languageEnglish (US)
Pages (from-to)67-71
Number of pages5
JournalOphthalmology
Volume121
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology

Fingerprint

Dive into the research topics of 'Dexamethasone implant anterior chamber migration: Risk factors, complications, and management strategies'. Together they form a unique fingerprint.

Cite this