Posters

A rare case of iatrogenic broken intralenticular Ozurdex™ implant

Poster Details

First Author: E. Ah-kee UNITED KINGDOM

Co Author(s):    L. Lim (first author)   V. Tanner                 

Abstract Details

Purpose:

Ozurdex™ (Allergan Pharmaceuticals) is a sustained release biodegradable steroid ocular implant containing 0.7mg dexamethasone and is licensed in the UK for the treatment of macular oedema secondary to retinal vein occlusion and for non-infectious posterior segment uveitis. In this report, we present a rare case of broken Ozurdex™ implant situated intra-lenticular following the injection.

Setting:

Royal Berkshire Hospital, United Kingdom

Methods:

A 48 year-old male was treated with Ozurdex™ intra-vitreal injection for uveitis secondary to sarcoidosis in the right eye. An ophthalmic trainee performed the procedure under aseptic conditions using the standard technique under supervision. On day 7 post-procedure, his visual acuity was 6/9. Slit lamp examination showed the implant broken in 2 pieces intra-lenticular with the entry site at the infero-temporal region and breached posterior capsule. No damage to surrounding structures or cataract formation was observed. However, it was noted that the breach in the posterior capsule had caused the lens material to be released, leading to more uveitic inflammation.

Results:

The stipulated mechanism of fracture is the possible rotation of the implant as it was injected through an angle pointing towards the posterior capsule (not the usual entry intra-vitreally), causing the implant to break. Due to the uveitic inflammation, a decision was made to proceed with cataract extraction and removal of the fractured implant. The lens was successfully removed and broken implant was repositioned through the original iatrogenic posterior capsule aperture without loss of vitreous. An intraocular lens was successfully placed in the capsular bag. At 3 months follow up, the lens remained in place and unaided visual acuity in the right eye was 6/9 with no macular oedema.

Conclusions:

There are a few reported cases of fractured Ozurdex™ implant during routine intra-vitreal injection for macular oedema, in which none of the patients suffered immediate consequential adverse effects. In contrast, this case illustrates a fractured implant injected for uveitis. A surgical approach was deemed appropriate due to exacerbation of inflammation and increased risk of cataract formation. With the emergence of microsurgical implant injection procedures clinicians should be aware of the potential risk of injecting the implant into an anatomical space other than the vitreous cavity. Adequate training and careful administration of the Ozurdex™ implant are necessary to avoid such complications.

Financial Disclosure:

NONE