title: Management of anterior chamber dislocation of a dexamethasone intravitreal implant: a case report.
abstract: BACKGROUND
  Ozurdex is a 700 mcg dexamethasone intravitreal implant, approved for the management of macular edema secondary to retinal vein occlusion, and other related pathoglogiesAnterior chamber dislocation of Ozurdex represents an uncommon complication of the intravitreal injection, which can be managed by repositioning the implant into the vitreous cavity. We describe the case of a successful repositioning of an Ozurdex implant by mobilization and subsequent balanced saline solution injection in the anterior chamber.
  
  
  METHODS
  An 83-year-old white woman presented to our Emergency Unit complaining of pain and vision loss in herright eye lasting a week. Her anamnesis revealed a history of persistent cystoid macular edema after phacoemulsification with scleral-fixated posterior chamber intraocular lens implantation, recently treated with an intravitreal Ozurdex implant. She also took a long-distance flight 2 days after the injection. An anterior segment examination showed corneal edema and the rod implant adherent to corneal endothelium. To avoid corneal decompensation, we opted for a implant repositioning. Under topical anesthesia, a 30-gauge needle was introduced through a limbar incisionto mobilize the dislocated rod. Balanced saline solution was injected, with a successful repositioning of the implant into the vitreous cavity. Topical 5 % hypertonic saline solution and 0.2 % betamethasone associated with 0.5 % chloramphenicol drops were administered four times a day. To prevent redislocation of the Ozurdex implant, she was instructed to avoid prone position, any kind of physical effort, and not to undertake long-distance flights during the first postoperative week. One week after surgery, an anterior segment examination showed an improvement of corneal edema. Funduscopy showed that the Ozurdex implant was settled into the vitreous cavity.
  
  
  CONCLUSIONS
  Anterior chamber dislocation of Ozurdex from the vitreous cavity is rare. In our patient, in addition to the posterior capsule tearing, the long-distance flight could have contributed to implant dislocation. Repositioning of the implant is necessary to avoid endothelial decompensation. It can be carried out by using saline balanced solution with the same efficacy as other surgical procedures reported in the literature. A possible disadvantage of this procedure could be implant migration.
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Pacella
authors.affiliation: Department of Biochemical Sciences, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Agostinelli
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Sandra Cinzia
authors.initials: SC
authors.lastname: Carlesimo
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Nebbioso
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Secondi
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Forastiere
authors.affiliation: Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Viale del Policlinico, 00161, Rome, Italy. elena.pacella@uniroma1.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Pacella
mesh_terms: D000369:Aged, 80 and over; D064870:Air Travel; D000867:Anterior Chamber / Q000473:pathology*; D003907:Dexamethasone / Q000008:administration & dosage*; D004343:Drug Implants; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections / Q000379:methods; D019654:Lens Implantation, Intraocular / Q000379:methods*; D007906:Lens Subluxation / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D004343:Drug Implants; D005938:Glucocorticoids; D003907:Dexamethasone
keywords: Case report; Cystoid macular edema; Intravitreal dexamethasone implant; Ozurdex; Ozurdex dislocation