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PHOTO ESSAY
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 268-269

Anterior chamber migration of intravitreal dexamethasone implant in glued intraocular lens


Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India

Date of Submission28-May-2018
Date of Acceptance17-Oct-2018
Date of Web Publication23-Jan-2019

Correspondence Address:
Dr. Dhivya Ashok Kumar
Dr. Agarwal's Eye Hospital and Eye Research Centre, 19, Cathedral Road, Chennai, Tamil Nadu - 600 086
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_841_18

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  Abstract 


Keywords: Dexamethasone implant migration, glued intraocular lens, ozurdex implant


How to cite this article:
Kumar DA, Dhawan A, Narayanan S, Agarwal A. Anterior chamber migration of intravitreal dexamethasone implant in glued intraocular lens. Indian J Ophthalmol 2019;67:268-9

How to cite this URL:
Kumar DA, Dhawan A, Narayanan S, Agarwal A. Anterior chamber migration of intravitreal dexamethasone implant in glued intraocular lens. Indian J Ophthalmol [serial online] 2019 [cited 2019 Apr 25];67:268-9. Available from: http://www.ijo.in/text.asp?2019/67/2/268/250686




  Cases Top


Case 1: A 61-year-old hypertensive male with glued intraocular lens (IOL) implantation 2 years ago presented with decreased vision in his right eye. Ozurdex implant was injected intravitreally a week ago for refractory macular edema. On examination, the right eye had well-centered glued IOL with corneal edema [Table 1], iris defect at 10 o'clock, and migrated Ozurdex implant [Figure 1] in the anterior chamber (AC).
Table 1: Demographic details of cases

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Figure 1: Case 1 (a) Clinical picture of migrated Ozurdex implant in the anterior chamber with glued IOL in situ and iris defect at 10 o'clock. (b) Ultrasound biomicroscopy picture showing well-centered glued IOL and the migrated implant

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Case 2: A 57-year-old diabetic male with glued IOL implantation with Ozurdex injection for diabetic macular edema [Figure 2]a and [Figure 2]b 3 weeks ago presented with decreased vision in his right eye. On examination, there was implant migration into the AC [Figure 3]a and [Figure 3]b with centered glued IOL.
Figure 2: Optical coherence tomography of case 2 before (a) and after (b) Ozurdex injection

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Figure 3: Case 2 (a) Preoperative clinical picture showing the Ozurdex implant in the anterior chamber. (b) Implant is being removed by “no touch technique” or viscoexpression. (c) Persistent decompensated cornea noted even after 1 month of implant removal (d) Pre Descemet's endothelial keratoplasty (PDEK) procedure performed. Intraoperative image showing the stripping of host Descemet's–endothelial complex under air with trocar anterior chamber maintainer in place (e) PDEK lenticule injected into the anterior chamber. (f) Pneumatic adhesion of PDEK graft at the end of the surgery

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Under peribulbar anesthesia using the viscoelastic device the implant was made to align perpendicular to the long axis of the incision and explanted with viscoexpression [Figure 3]a and [Figure 3]b by counter pressure on the posterior lip. Case 2 required pre Descemet's endothelial keratoplasty (PDEK) for corneal decompensation [Figure 3]c, [Figure 3]d, [Figure 3]e, [Figure 3]f after a month.


  Discussion Top


Ozurdex migration into the AC was initially reported with iris-fixated IOL requiring corneal transplantation.[1],[2] Owing to the proximity to the uvea, the sulcus, AC IOL, or iris fixated IOLs may require steroid implants to control inflammation.[3],[4] However, the inflammatory response is less with glued IOL.[5] Both cases in our report had corneal edema, whereas case 2 required PDEK. The proximity to the endothelium and the greater rigidity of the implant soon after injection may be the probable risk factors for corneal edema. Deficient capsules, iridectomy, zonular dialysis, and prior vitrectomy are known threats for implant migration. Our report showed that even a well-centered glued IOL may not prevent this migration, and hence, the need for meticulous follow-up should be emphasized.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pardo-López D, Francés-Muñoz E, Gallego-Pinazo R, Díaz-Llopis M. Anterior chamber migration of dexamethasone intravitreal implant (Ozurdex ®). Graefes Arch Clin Exp Ophthalmol 2012;250:1703-4.  Back to cited text no. 1
    
2.
Rahimy E, Khurana RN. Anterior segment migration of dexamethasone implant: Risk factors, complications, and management. Curr Opin Ophthalmol 2017;28:246-51.  Back to cited text no. 2
    
3.
Amino K, Yamakawa R. Long-term results of out-of-the-bag intraocular lens implantation. J Cataract Refract Surg 2000;26:266-70.  Back to cited text no. 3
    
4.
Evereklioglu C, Er H, Bekir NA, Borazan M, Zorlu F. Comparison of secondary implantation of flexible open-loop anterior chamber and scleral-fixated posterior chamber intraocular lenses. J Cataract Refract Surg 2003;29:301-8.  Back to cited text no. 4
    
5.
Kumar DA, Agarwal A, Packialakshmi S, Agarwal A. In vivo analysis of glued intraocular lens position with ultrasound biomicroscopy. J Cataract Refract Surg 2013;39:1017-22.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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