title: Dexamethasone implant anterior chamber migration: risk factors, complications, and management strategies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Fifteen patients had 18 episodes of migration of the DEX implant into the anterior chamber.
  
  
  METHODS
  The medical records of 15 patients with spontaneous migration of a DEX implant were retrospectively reviewed.
  
  
  METHODS
  Migration of the DEX implant into the anterior chamber.
  
  
  RESULTS
  Migration of a DEX intravitreal implant into the anterior chamber occurred in 6 patients who were aphakic, 4 patients with an anterior chamber intraocular lens, 2 patients with a scleral-fixated posterior chamber intraocular lens (PCIOL), 2 patients with a PCIOL, and 1 patient with an iris-fixated PCIOL. All 15 patients had prior pars plana vitrectomy, and 14 patients (93%) had no lens capsule. The average interval from DEX implant injection to detection of the implant migration into the anterior chamber was 13 days (range, 5-44 days). In 14 patients, corneal edema developed. Among those eyes undergoing surgical removal of the implant, earlier intervention reduced the likelihood of permanent corneal edema (0.5 days [from diagnosis of migration to surgical removal of the implant] vs. 5.5 days; P = 0.04). Aspiration was necessary to remove the implant in 6 patients. Among the 14 patients with corneal edema, the corneal edema did not resolve in 10 patients (71%), 6 (43%) of whom required corneal transplantation.
  
  
  CONCLUSIONS
  Absence of lens capsule and prior vitrectomy are risk factors for migration of the DEX implant into the anterior chamber. Early removal of the implant may be necessary to minimize the risk of chronic corneal edema.
authors.affiliation: Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California. Electronic address: rnkhurana@gmail.com.
authors.forename: Rahul N
authors.initials: RN
authors.lastname: Khurana
authors.affiliation: Southern California Permanente Medical Group, Anaheim, California.
authors.forename: Suri N
authors.initials: SN
authors.lastname: Appa
authors.affiliation: Jules Stein Eye Institute, Los Angeles, California.
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.affiliation: Elman Retina Group, Baltimore, Maryland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Elman
authors.affiliation: Houston Eye Associates, Houston, Texas.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wittenberg
authors.affiliation: Retina Vitreous Consultants, Beverly Hills, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Parks
authors.affiliation: Coburn-Kleinfeldt Eye Clinic, Livonia, Michigan.
authors.forename: Saad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia.
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
mesh_terms: D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000473:pathology*; D001036:Aphakia, Postcataract / Q000150:complications; D015715:Corneal Edema / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016039:Corneal Transplantation; D020878:Device Removal; D003907:Dexamethasone / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D019591:Pseudophakia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D014821:Vitrectomy; D014822:Vitreous Body
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D003907:Dexamethasone