A Case of Repeated Intravitreal Dexamethasone Implantation for Treatment of Macular Edema after Scleral Fixation of Intraocular Lens

Abstract

The purpose of this case was to report a case of repeated dexamethasone intravitreal implant (Ozurdex; Allergan Inc., Irvine, CA, USA) migration into the anterior chamber without any corneal complications in a patient with cystoid macular edema. A 70-year-old male patient had decreased vision due to cystoid macular edema after scleral fixation of a dislocated intraocular lens in his right eye. He had repeated intravitreal bevacizumab injection but macular edema showed little improvement. Macular edema improved after intravitreal dexamethasone implantation but he needed repeated implantation since macular edema recurred as the therapeutic effect of the implant decreased. After the third implantation, 70 days later, the implant was observed in the anterior chamber, and the intraocular pressure (IOP) measured 46 mm Hg, while the cornea remained clear. We decided to have a close follow-up with IOP control since no corneal edema was seen. The implant was completely absorbed after 40 days with clear cornea and another intravitreal dexamethasone implantation was performed owing to increasing macular edema. The implant was seen in the anterior chamber again after 78 days but no corneal edema was seen and IOP was normal. After 1 month the implant was completely absorbed and intravitreal dexamethasone implantation was repeated. Migration of dexamethasone intravitreal implant may happen in a patient with posterior capsular defect but the treatment could be maintained under close observation in absence of corneal complications.