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      Anterior Chamber Dislocation of Dexamethasone Implant in the Presence of Carlevale Sutureless Scleral Fixation Intraocular Lens

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          Abstract

          Dexamethasone intravitreal implant (Ozurdex ®; Allergan, Inc., CA, USA) has been proved to be effective in a variety of clinical settings including cases of pseudophakic cystoid macular edema. Uncommonly, this implant can migrate from the vitreous cavity and into the anterior chamber, especially in vitrectomized eyes with lens capsule defects. We report herein a rare case of anterior chamber migration and illustrate the passageway of the dexamethasone intravitreal implant through a new type of scleral fixated lens, the Carlevale IOL (Soleko-Italy). A 78-year-old woman was left aphakic following a complicated right eye hypermature cataract surgery with posterior capsule rupture and zonular dehiscence. Shortly thereafter, she underwent a planned combined pars plana vitrectomy with the placement of a Carlevale sutureless scleral fixated intraocular lens for the treatment of her aphakia. Due to a subsequent persistent cystoid macular edema that was unresponsive to topical treatment and sub-tenon corticosteroids, an intravitreal dexamethasone implant was injected. Eleven days after implantation, the patient presented with a floating implant in the anterior chamber and corneal edema. Following an immediate surgical removal, corneal edema resolved and visual acuity improved. One year later, results remain stable without macular edema recurrence. Anterior chamber migration of the Ozurdex implant is a potential complication in vitrectomized eyes, even when new types which are larger and specially designed for scleral fixation intraocular lenses are utilized. Corneal complications can be reversible following an immediate removal of the implant.

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          Most cited references6

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          • Article: not found

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

          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.
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            Safety of 6000 intravitreal dexamethasone implants

            To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.
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              • Record: found
              • Abstract: found
              • Article: not found

              Desegmentation of Ozurdex implant in vitreous cavity: report of two cases.

              To report two cases of desegmentation or fracture of the Ozurdex implant observed immediately after routine intravitreal implantation for macular oedema.
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                Author and article information

                Journal
                Case Rep Ophthalmol
                Case Rep Ophthalmol
                COP
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Basel, Switzerland )
                1663-2699
                23 May 2023
                Jan-Dec 2023
                23 May 2023
                : 14
                : 1
                : 229-233
                Affiliations
                [a ]Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
                [b ]Department of Ophthalmology, 251 Hellenic Airforce General Hospital, Athens, Greece
                Author notes
                Correspondence to: Styliani Totou, stellatotou@ 123456gmail.com
                Article
                529790
                10.1159/000529790
                10293962
                37383169
                e2f4fb8d-a5ef-4b82-8d4b-ed210fc10072
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 27 January 2023
                : 1 February 2023
                : 2023
                Page count
                Figures: 3, References: 6, Pages: 5
                Funding
                No funding or grant support was received. All the authors attest that they meet the current ICMJE criteria for authorship.
                Categories
                Case Report

                ozurdex,dexamethasone implant,carlevale,scleral fixated lens,anterior chamber migration

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