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Khor HG, Lott PW, Wan Ab Kadir AJ, Singh S, Iqbal T. Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports. J Ocul Pharmacol Ther 2024; 40:342-360. [PMID: 37676992 DOI: 10.1089/jop.2023.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).
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Affiliation(s)
- Hui Gim Khor
- University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Ophthalmology, Miri Hospital, Ministry of Health Malaysia, Sarawak, Malaysia
| | - Pooi Wah Lott
- University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azida Juana Wan Ab Kadir
- University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Sujaya Singh
- University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Tajunisah Iqbal
- University of Malaya Eye Research Centre (UMERC), Department of Ophthalmology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Tsoutsanis P, Kapantais D. Anterior migration of Ozurdex implant: a review on risk factors, complications, and management. Int J Retina Vitreous 2023; 9:74. [PMID: 38012689 PMCID: PMC10683211 DOI: 10.1186/s40942-023-00513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To describe the common risk factors, complications, and management options for anterior migration of Ozurdex implant. METHODS A comprehensive review of the literature was performed. RESULTS Amongst the most common risk factors predisposing to implant anterior migration we found a history of pseudophakia or aphakia or previous vitrectomy. The most common complication is that of corneal edema. CONCLUSIONS A variety of management options to treat migration of the dexamethasone implant are utilized by different specialists around the world. These depend on the doctor's preference, presence of corneal damage and history of previous migrations after repositioning the implant. The most common approaches are operative or non-operative implant repositioning and surgical implant removal.
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Affiliation(s)
- Panagiotis Tsoutsanis
- Northern Care Alliance NHS Foundation Trust, Rochdale Eye Unit, Rochdale Infirmary, Greater Manchester, UK.
| | - Dimitrios Kapantais
- Northern Care Alliance NHS Foundation Trust, Rochdale Eye Unit, Rochdale Infirmary, Greater Manchester, UK
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Trovato Battagliola E, Riveros Cabral RJ, Manco G, Puggioni G, Brancato C, Mangiantini P, Testa F, Malvasi M, Raponi G, Turchetti P, Pacella F, Pacella E. Topical antibiotic prophylaxis before intravitreal injections: a pilot study. Graefes Arch Clin Exp Ophthalmol 2023; 261:2953-2959. [PMID: 37199800 DOI: 10.1007/s00417-023-06113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To explore whether topical antibiotic prophylaxis in patients scheduled for intravitreal injections achieves surface sterility in a greater proportion of subjects as compared to povidone-iodine alone. MATERIAL AND METHODS A randomized, triple-blind clinical trial. POPULATION patients scheduled for intravitreal injections for maculopathy. INCLUSION CRITERIA any sex and race, age 18 years and above. Subjects were randomized into 4 groups: the first group applied chloramphenicol (CHLORAM), the second netilmicin (NETILM), the third a commercial ozonized antiseptic solution (OZONE), and the fourth applied no drops (CONTROL). OUTCOME VARIABLE percentage of non-sterile conjunctival swabs. Specimens were collected before and after the application of 5% povidone-iodine moments before the injection. RESULTS Ninety-eight subjects (33.7% females, 64.3% males), mean age: 70.2 ± 9.3 years (54-91). Before povidone-iodine, both the CHLORAM and NETILM group showed a lower percentage of non-sterile swabs (61.1% and 31.3% respectively), as compared to the OZONE (83.3%) and CONTROL (86.5%) groups (p < .04). However, this statistical difference was lost after the application of povidone-iodine for 3 min. Percentage of non-sterile swabs in each group after applying 5% povidone-iodine: CHLORAM 11.1%, NETILM 12.5%, CONTROL 15.4%, OZONE 25.0%. This was not statistically significant (p > .05). CONCLUSIONS Topical antibiotic prophylaxis with chloramphenicol or netilmicin drops decreases the bacterial load on the conjunctiva. However, after the application of povidone-iodine, all groups showed a significant reduction in the percentage of non-sterile swabs, and this value was comparable among all groups. For this reason, authors conclude that povidone-iodine alone is sufficient and prior topical antibiotic prophylaxis is not indicated.
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Affiliation(s)
- Edoardo Trovato Battagliola
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Rodolfo Javier Riveros Cabral
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Gregorio Manco
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Gianluca Puggioni
- Department of Diagnostic Medicine and Radiology, UOC Microbiology and Virology, Azienda Policlinico Umberto I, Rome, Italy
| | - Claudio Brancato
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Pietro Mangiantini
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Floriana Testa
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Mariaelena Malvasi
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Faculty of Pharmacy and Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Turchetti
- National Institute for Health Migration and Poverty, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy
| | - Elena Pacella
- Department of Sense Organs, Sapienza" University of Rome, Policlinico Umberto I, Viale, del Policlinico 155, 00161, Rome, Italy.
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Ahuja AS, Jaraki JA, Halperin LS. OFFICE MANAGEMENT OF OZURDEX IMPLANT DISLOCATION INTO THE ANTERIOR CHAMBER. Retin Cases Brief Rep 2023; 17:170-172. [PMID: 33731604 DOI: 10.1097/icb.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To describe a novel office procedure that permits the repositioning of an Ozurdex implant from the anterior chamber back into the vitreous cavity. METHODS Description of an office technique for Ozurdex repositioning using a 30-gauge needle. RESULTS In both cases, the Ozurdex implant was successfully returned to the vitreous cavity. In Case 1, the patient's visual acuities 1 and 2 weeks after this were 20/70 and 20/40, respectively, and had no further complications. In Case 2, the patient returned 1 week later, with the implant remaining posterior and a visual acuity of 20/40. CONCLUSION The success of this novel technique in these cases demonstrates the potential to avoid a surgical procedure in the event of Ozurdex implant migration to the anterior chamber, while at the same time allowing the Ozurdex implant to remain effective in the eye.
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Affiliation(s)
- Abhimanyu S Ahuja
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; and
| | - Jude A Jaraki
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; and
| | - Lawrence S Halperin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; and
- Retina Group of Florida, Ft. Lauderdale, Florida
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Qin X, Zou H. The role of lipopolysaccharides in diabetic retinopathy. BMC Ophthalmol 2022; 22:86. [PMID: 35193549 PMCID: PMC8862382 DOI: 10.1186/s12886-022-02296-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/03/2022] [Indexed: 11/29/2022] Open
Abstract
Diabetes mellitus (DM) is a complex metabolic syndrome characterized by hyperglycemia. Diabetic retinopathy (DR) is the most common complication of DM and the leading cause of blindness in the working-age population of the Western world. Lipopolysaccharides (LPS) is an essential ingredient of the outer membrane of gram-negative bacteria, which induces systemic inflammatory responses and cellular apoptotic changes in the host. High-level serum LPS has been found in diabetic patients at the advanced stages, which is mainly due to gut leakage and dysbiosis. In this light, increasing evidence points to a strong correlation between systemic LPS challenge and the progression of DR. Although the underlying molecular mechanisms have not been fully elucidated yet, LPS-related pathobiological events in the retina may contribute to the exacerbation of vasculopathy and neurodegeneration in DR. In this review, we focus on the involvement of LPS in the progression of DR, with emphasis on the blood-retina barrier dysfunction and dysregulated glial activation. Eventually, we summarize the recent advances in the therapeutic strategies for antagonising LPS activity, which may be introduced to DR treatment with promising clinical value.
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Affiliation(s)
- Xinran Qin
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China. .,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China. .,National Clinical Research Center for Eye Diseases, Shanghai, China. .,Shanghai Key Laboratory of Fundus Diseases, Shanghai, China.
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ANTERIOR MIGRATION OF INTRAVITREAL FLUOCINOLONE ACETONIDE IMPLANTS: A CASE REPORT. Retin Cases Brief Rep 2022; 16:67-69. [PMID: 31339874 DOI: 10.1097/icb.0000000000000897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE To describe management of anterior migration of a fluocinolone acetonide(FAc) intravitreal implant. METHODS A retrospective case report. A 61-year-old man with diabetic macular edema and prior vitrectomy had anterior migration of a FAc implant. Anterior segment photos and optical coherence tomography were performed. RESULTS Approximately 3 months after FAc implant was administered, it was noted to have migrated into the anterior chamber. Vision, intraocular pressure, and optical coherence tomography imaging initially remained stable, and no evidence of detectable corneal edema developed in 30 months of follow-up. However, at 36 months of follow-up, after second FAc implant injection, mild corneal edema developed,suspected to be related to the migrating implants. CONCLUSION Anterior migration of a FAc implant may lead to less rapid and severe corneal decompensation compared with other steroid implants. Despite this, delayed corneal edema may occur. Careful monitoring of the cornea and intraocular pressure is recommended in cases of anterior FAc migration.
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Chang SM, St Peter DM, Im LT, Munir WM, Schocket LS. Dexamethasone implant migration in an eye with congenital glaucoma: A case report and review of the literature. Eur J Ophthalmol 2021; 32:NP46-NP50. [PMID: 33781105 DOI: 10.1177/11206721211005696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The dexamethasone (DEX) implant is an FDA approved treatment for diabetic macular edema, non-infectious posterior uveitis, and macular edema secondary to branch or central retinal vein occlusions. We describe a case of anterior chamber (AC) migration of a DEX implant in a patient with a history of congenital glaucoma and perform a review of the literature on this particular complication, summarizing the common risk factors, subsequent complications, and management options. CASE DESCRIPTION A 46-year-old female with a history of congenital glaucoma, status post cataract extraction with insertion of intraocular lens, pars plana vitrectomy, and Baerveldt tube implant in the left eye was referred for post-operative cystoid macular edema (CME). The patient underwent insertion of a DEX implant, resulting in improvement in her CME. After the fourth implant was injected, the patient noticed a white line in her eye while looking in the mirror after doing jumping jacks. Slit lamp examination confirmed migration of the implant into the AC. Ultimately, the patient was taken to the operating room, where her implant was removed via bimanual vitrectomy through an anterior approach. CONCLUSION This case report and literature review explores the ophthalmic structural changes specific to congenital glaucoma which may have predisposed this eye to anterior migration of the DEX implant. The purpose of this review is to detail the anatomic changes that may increase the risk of anterior chamber implant migration in patients with congenital glaucoma so that physicians may be aware of these risks when selecting patients for this implant.
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Affiliation(s)
- Sarah M Chang
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deidre M St Peter
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lily T Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lisa S Schocket
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Berisha B, Höflechner L, Wedrich A. Disloziertes Dexamethason-Implantat in der Vorderkammer: ein Fallbericht. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-020-00481-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund
Ozurdex® (Allergan Pharmaceuticals Ireland, Westport, Co. Mayo, Irland) ist ein intravitreales Implantat von 700 mcg Dexamethason, das für die Behandlung eines Makulaödems infolge eines retinalen Venenverschlusses, einer nichtinfektiösen posterioren Uveitis und einer diabetischen Makulopathie zugelassen ist. Erhöhter Augeninnendruck sowie Trübungen der kristallinen Linse sind bekannte Komplikationen. Seltener wird in der Literatur auch die unerwünschte Migration des Implantates in die Vorderkammer (VK) beschrieben. Laut Literatur erforderten die meisten Implantatdislokationen in die VK eine operative Entfernung oder Reposition in den Glaskörperraum. Wir berichten die erfolgreiche Repositionierung eines Ozurdex®-Implantats durch die medikamentöse Erweiterung der Pupille.
Falldarstellung
Eine 79-jährige Patientin entwickelte nach einer sekundären Intraokularlinsenimplantation ein persistierendes zystoides Makulaödem am linken Auge. Dieses wurde seit 3 Jahren mit intravitrealem Ozurdex® behandelt. Bei der geplanten Kontrolle 4 Wochen nach der letzten Behandlung wurde das Ozurdex®-Stäbchen in der VK zwischen Iris und Optik der Vorderkammerlinse (VKL) festgestellt. Es erfolgte eine medikamentöse Erweiterung der Pupille, um das dislozierte Stäbchen zu mobilisieren. Die anschließende Spaltlampenuntersuchung und Fundoskopie zeigten eine Rücklagerung des Ozurdex®-Implantates in dem Glaskörperraum.
Schlussfolgerungen
Die Entfernung des Ozurdex®-Stäbchens aus der VK ist notwendig, um eine Dekompensation des Hornhautendothels zu vermeiden. Wir empfehlen vor einer chirurgischen Intervention einen Repositionsversuch des Implantats durch die medikamentöse Erweiterung der Pupille.
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Pacella E, Loffredo L, Malvasi M, Trovato Battagliola E, Messineo D, Pacella F, Arrico L. Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study. Clin Ophthalmol 2020; 14:3611-3617. [PMID: 33154620 PMCID: PMC7605966 DOI: 10.2147/opth.s265691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants. Materials and Methods A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards. Results Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and -0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and -0.66 mmHg (T3) (p < 0.05). Conclusion Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30-90 days following the implantation procedure and responds well to topical pressure-lowering medications.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | | | | | - Daniela Messineo
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Loredana Arrico
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
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Goel N, Mehta A, Batra J, Choudhry R. Anterior Chamber Migration of Intravitreal Dexamethasone Implant in an Eye with Scleral-fixated Intraocular Lens. J Ophthalmic Vis Res 2020; 15:581-583. [PMID: 33133453 PMCID: PMC7591832 DOI: 10.18502/jovr.v15i4.7798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Neha Goel
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Aanchal Mehta
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Jyoti Batra
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
| | - Reena Choudhry
- Department of Ophthalmology, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India
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Hernanz I, Moll-Udina A, Dotti-Boada M, Carrión MT, Llorenç V, Adán A. Non-pharmacological complications associated with Intravitreal dexamethasone implant injection. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:471-477. [PMID: 32654825 DOI: 10.1016/j.oftal.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Intravitreal dexamethasone implant (IID) is an effective and safe treatment for macular oedema as described in the literature. Ocular hypertension and cataracts are the most frequent complications. The indications of IID in the last few years have led to the retrospective reporting of rare complications, with potential visual impact related to the injection procedure. METHODS A case series is presented of fifteen patients treated with IID for macular oedema who developed non-pharmacological complications related to the injection procedure or the implant itself, including, among others anterior chamber migration, intracrystalline injection, endophthalmitis, or segmentation. Differentiation was made between true complications and those that did not lead to any ocular damage. Epidemiological and baseline data were collected along with the treatment and outcome in each case. An analysis was made of multimodal imaging available. RESULTS The incidence of complications was 0.65% in this series Anterior chamber migration was the most frequent complication (n=4), followed by intracrystalline injection, and endophthalmitis (n=2). The times between the injection and complications were variable. Visual impairment was the most common symptom (n=6). However, despite the complications found, IID was an effective treatment in most of the reported cases. CONCLUSIONS Clinicians should be aware of these rare non-pharmacological complications so that they may be prevented and detected early, avoiding irreversible ocular damage.
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Affiliation(s)
- I Hernanz
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España.
| | - A Moll-Udina
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M Dotti-Boada
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - M T Carrión
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - V Llorenç
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
| | - A Adán
- Instituto Clínico de Oftalmología, Hospital Clinic, Barcelona, España
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12
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Moshirfar M, Murri MS, Shah TJ, Skanchy DF, Tuckfield JQ, Ronquillo YC, Birdsong OC, Hofstedt D, Hoopes PC. A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment. Ophthalmol Ther 2019; 8:195-213. [PMID: 30859513 PMCID: PMC6514041 DOI: 10.1007/s40123-019-0169-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 12/13/2022] Open
Abstract
The corneal endothelium plays an integral role in regulating corneal hydration and clarity. Endotheliitis, defined as inflammation of the corneal endothelium, may disrupt endothelial function and cause subsequent visual changes. Corneal endotheliitis is characterized by corneal edema, the presence of keratic precipitates, anterior chamber inflammation, and occasionally limbal injection, neovascularization, and co-existing or superimposed uveitis. The disorder is classified into four subgroups: linear, sectoral, disciform, and diffuse. Its etiology is extensive and, although commonly viral, may be medication-related, procedural, fungal, zoological, environmental, or systemic. Not all cases of endothelial dysfunction leading to corneal edema are inflammatory in nature. Therefore, it is imperative that practitioners consider a broad differential for patients presenting with possible endotheliitis, as well as familiarize themselves with appropriate diagnostic and therapeutic modalities.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
- HDR Research Center, Hoopes Vision, Draper, UT, USA.
| | - Michael S Murri
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Tirth J Shah
- Department of Ophthalmology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa, IA, USA
| | - David F Skanchy
- McGovern Medical School, The University of Texas Health Science Center, Houston, TX, USA
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James Q Tuckfield
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | | | - Daniel Hofstedt
- Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, MO, USA
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Röck D, Bartz-Schmidt KU, Röck T. Risk factors for and management of anterior chamber intravitreal dexamethasone implant migration. BMC Ophthalmol 2019; 19:120. [PMID: 31138164 PMCID: PMC6537356 DOI: 10.1186/s12886-019-1122-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). Methods A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher’s exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. Results Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). Conclusions The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.
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Affiliation(s)
- D Röck
- Centre for Ophthalmology, University of Tübingen, Elfriede-Aulhorn-Straße 7, D-72076, Tübingen, Germany.
| | - K U Bartz-Schmidt
- Centre for Ophthalmology, University of Tübingen, Elfriede-Aulhorn-Straße 7, D-72076, Tübingen, Germany
| | - T Röck
- Centre for Ophthalmology, University of Tübingen, Elfriede-Aulhorn-Straße 7, D-72076, Tübingen, Germany
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Majumder PD, Palkar AH, Pathare N, Biswas J. Anterior chamber migration of a sustained-release dexamethasone intravitreal implant: A case report and review of literature. Oman J Ophthalmol 2019; 12:133-137. [PMID: 31198303 PMCID: PMC6561047 DOI: 10.4103/ojo.ojo_5_2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The purpose of the study was to report a case of migration of a dexamethasone intravitreal implant (Ozurdex®) into anterior chamber and review the literature pertaining to the anterior chamber migration of implant. Clinical data were collected from a patient, in whom a dexamethasone intravitreal implant migrated to anterior chamber. A review of literature was conducted to analyze additional reports. A 59-year-old aphakic patient with recalcitrant cystoid macular edema due to chronic idiopathic uveitis was treated with intravitreal injection of dexamethasone implant. Migration of the implant into anterior chamber was noted after a month of injection. Since his cornea was clear and intraocular pressure was normal, he was managed conservatively. Sixteen such reports of migration of implant into anterior chamber was analyzed to look into the possible etiologies and outcome. Disruption of lens capsule, large basal iridectomy, and prior vitrectomy are the primary risk factors for migration of dexamethasone implant into the anterior chamber.
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Affiliation(s)
| | - Amit H Palkar
- Department of Uvea and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Nikita Pathare
- Post Graduate Trainee and Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Uvea and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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15
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Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci 2018; 19:ijms19061816. [PMID: 29925789 PMCID: PMC6032159 DOI: 10.3390/ijms19061816] [Citation(s) in RCA: 610] [Impact Index Per Article: 101.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 02/07/2023] Open
Abstract
Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM). It has long been recognized as a microvascular disease. The diagnosis of DR relies on the detection of microvascular lesions. The treatment of DR remains challenging. The advent of anti-vascular endothelial growth factor (VEGF) therapy demonstrated remarkable clinical benefits in DR patients; however, the majority of patients failed to achieve clinically-significant visual improvement. Therefore, there is an urgent need for the development of new treatments. Laboratory and clinical evidence showed that in addition to microvascular changes, inflammation and retinal neurodegeneration may contribute to diabetic retinal damage in the early stages of DR. Further investigation of the underlying molecular mechanisms may provide targets for the development of new early interventions. Here, we present a review of the current understanding and new insights into pathophysiology in DR, as well as clinical treatments for DR patients. Recent laboratory findings and related clinical trials are also reviewed.
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Affiliation(s)
- Wei Wang
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Amy C Y Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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16
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Ha JY, Jang JY, Ji YS. Management of Anterior Chamber Migration of Dexamethasone Intravitreal Implant. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 31:574-575. [PMID: 29230981 PMCID: PMC5726995 DOI: 10.3341/kjo.2017.0100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jun Young Ha
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Yong Jang
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Sok Ji
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
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17
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Sandhu HS, Kaplan HJ. Novel therapies in the treatment of noninfectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1477590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Harpal Singh Sandhu
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Henry J Kaplan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Louisville, Louisville, KY, USA
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18
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Lin HY, Lee CY, Huang JY, Yang SF, Chao SC. Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e8868. [PMID: 29382007 PMCID: PMC5709006 DOI: 10.1097/md.0000000000008868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To evaluate the safety and efficiency in macular edema patients who concurrently received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg) and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and ranibizumab injections with a follow-up period of at least 3 months were enrolled in the study group. An age and gender-matched group received ranibizumab injections and was designated the control group. The best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined as either an elevation of more than 10 mmHg from baseline or a single IOP measurement of more than 30 mmHg.A total of 26 patients were enrolled in the current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P < .01) achieved significant improvement after the follow-up period in the study group. The IOP increased after the injection but no significant elevation was observed throughout the follow-up period in the study group (P = .15). For SIOH, 1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2 postoperative months, and no single IOP measurement of more than 30 mmHg was obtained. Five patients (38.5%) in the study group received medical treatment that successfully retarded their IOP elevation, and no individuals required surgical management. In the control group, there were no significant fluctuations concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According to the inter-group analysis, the CMT and BCVA recovered more significantly in the study group than in the control group.Concurrent injection of DEX and ranibizumab is a preliminary method that shows effectiveness in treating ME. Furthermore, safety is also guaranteed, with moderate levels of severity and transient IOP elevation being observed. A future large-scale study is necessary to evaluate the long-term effects and safety of this combined treatment.
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Affiliation(s)
- Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
- Institute of Medicine
- Department of Optometry, Chung Shan Medical University, Taichung
- Department of Optometry, Yuanpei University of Medical Technology, Hsinchu
| | - Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - Shun-Fa Yang
- Institute of Medicine
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung
| | - Shih-Chun Chao
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua
- Department of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu
- Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan
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Ramu J, Chatziralli I, Yang Y, Menon G, Bailey C, Eckstein M, Hykin P, Sivaprasad S. Health-related quality of life, visual function and treatment satisfaction following intravitreal dexamethasone implant for diabetic macular edema. Patient Prefer Adherence 2017; 11:579-586. [PMID: 28360511 PMCID: PMC5364019 DOI: 10.2147/ppa.s132859] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to explore and describe quantitatively patient-reported outcome measures (PROMs), ie, health-related quality of life (QoL), visual function and treatment satisfaction, in patients with diabetic macular edema (DME) receiving two different regimens of Ozurdex (intravitreal dexamethasone implant). METHODS In this multicenter, prospective study, 100 patients with center-involving refractory DME were randomized 1:1 to either five monthly fixed dosing or optical coherence tomography (OCT)-guided pro re nata (PRN) regimen of dexamethasone intravitreal implant therapy. The primary outcome was the difference between arms in change in PROMs and health-related QoL from baseline to 12 months, as measured by the Retinopathy-Dependent Quality of Life (RetDQoL) questionnaire, Visual Function Questionnaire-25 (VFQ-25) and Retinopathy Treatment Satisfaction Questionnaire (RetTSQ). RESULTS There was no statistically significant difference in the RetDQoL score and VFQ-25 score at month 12 compared to those at baseline, whereas the total mean RetTSQ score increased significantly at the exit visit. The two treatment arms did not differ significantly regarding the change in PROMs and health-related QoL questionnaires. Logistic regression analysis showed that visual acuity (VA) of ≥55 letters, central foveal thickness <300 μm and macular volume <9.2 mm3 at the exit visit (month 12) predicted a higher change in RetTSQ. CONCLUSION This study showed that there is a statistically significant improvement in treatment satisfaction, as measured by RetTSQ, in patients with DME treated with dexamethasone intravitreal implant, independent of the dose regimen, namely, fixed or PRN. However, it should be noted that the clinically meaningful change could not be assessed accurately, since no thresholds for clinically meaningful change currently exist for the RetTSQ. On the other hand, there was no significant change in health-related QoL, as measured using VFQ-25 and RetDQoL. Factors affecting the patients' treatment satisfaction were the final VA, the central foveal thickness and the macular volume.
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Affiliation(s)
| | | | - Yit Yang
- The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton
| | | | | | | | - Phil Hykin
- NIHR Moorfields Biomedical Research Centre, London
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, London
- Correspondence: Sobha Sivaprasad, NIHR Moorfields Biomedical Research Centre, 162 City Road, EC1V 2PD, London, UK, Tel +44 20 7566 2039, Fax +44 20 7566 2472, Email
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