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 Table of Contents    
CLINICAL IMAGE
Year : 2021  |  Volume : 14  |  Issue : 3  |  Page : 201-202  

Fractured dexamethasone implant (OZURDEX®) following intravitreal injection


1 Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh; Ophthalmology Department, Imam Abdulrahman bin Faisal university, Dammam, Saudi Arabia
2 Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh; Ophthalmology Department, Taif University, Taif, Saudi Arabia
3 Vitreoretinal Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia

Date of Submission27-Jan-2021
Date of Decision09-Apr-2021
Date of Acceptance06-May-2021
Date of Web Publication20-Oct-2021

Correspondence Address:
Dr. Abdulaziz M Al-Shehri
Vitreo Retina Unit, King Khaled Eye Specialist Hospital, P.O.B: 7191, Riyadh 11462
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.ojo_31_21

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   Abstract 


Dexamethasone implant (Ozurdex™) is a relatively safe medication with few adverse events can happen. We demonstrate clinical course and images of a rare case of fractured intravitreal Ozurdex™ implant that observed immediately following injection and its final outcome.

Keywords: Intravitreal injection, macular edema, ozurdex


How to cite this article:
Aljohani SM, Al-Shehri AM, Al-Rubaie KR. Fractured dexamethasone implant (OZURDEX®) following intravitreal injection. Oman J Ophthalmol 2021;14:201-2

How to cite this URL:
Aljohani SM, Al-Shehri AM, Al-Rubaie KR. Fractured dexamethasone implant (OZURDEX®) following intravitreal injection. Oman J Ophthalmol [serial online] 2021 [cited 2021 Dec 8];14:201-2. Available from: https://www.ojoonline.org/text.asp?2021/14/3/201/328607



This is a 72-year-old diabetic patient who have macular edema secondary to old ischemic central retinal vein occlusion in the left eye. His best-corrected visual acuity (BCVA) was 20/400 and intraocular pressure (IOP) was 15 mmHg. Slit-lamp examination revealed clear cornea, no rubeosis, deep and quite anterior chamber with posterior chamber intraocular lens in place. Dilated fundus exam showed cleared vitreous, pale disc, dilated tortuous veins, cotton wall spots, and nerve fiber layer hemorrhages in each of the quadrants [Figure 1]. Optical coherence tomography (OCT) revealed large cystic ME (780 μ) with interruption of the ellipsoid zone [Figure 2].
Figure 1: Immediately after injection, Ultra-wide field retinal image showing Fractured Ozurdex™ implant inside the vitreous cavity

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Figure 2: Immediately after injection, optical coherence tomography image of the left eye showing huge macular edema

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The patient had received different types of anti-vascular endothelial growth factors injections over the past 1 year with poor functional and anatomical outcomes in his nonvitrectomized eye, so the decision made to give him sustained-released 0.7 mg dexamethasone intravitreal implant (OZURDEX®; Allergan, Inc., Irvine, CA, USA).

Following the acquisition of voluntary, informed, and written consent from the patient, OZURDEXR implantation was undertaken using the standard technique.[1] Administration of the injection took place using sterile conditions, and the 22G applicator supplied by the manufacturer was inserted in the inferotemporal quadrant after the subconjunctival anesthetic agent. The actuator button was pressed down until it clicked, and the needle was extracted. The procedure was uneventful. Using indirect ophthalmoscopy after the injector had been withdrawn, the OZURDEXR implant had fractured into two parts inside the vitreous cavity. Other than this, the implant was stable, and it did not lead to iatrogenic vitreoretinal damage [Figure 1].

At 2-month follow-up, the patient's BCVA had improved to 20/100 with normal IOP. Fundus examination revealed flat retina and stable fractured OZURDEXR implant in the vitreous cavity [Figure 3] while the OCT showed restoration of the foveal contour with decrease macular thickness [Figure 4].
Figure 3: At 2-month follow-up, ultra-wide field retinal image of the left eye showing Flat retina, stable fractured Ozurdex™ implant

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Figure 4: At 2-month follow-up, optical coherence tomography image of the left eye showing improvement of macular edema

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In the literature, hemorrhage, eye pain, cataract, conjunctival hyperemia, maculopathy, and ocular hypertension are the most prevalent adverse outcomes arising from OZURDEXR implant, with reported rates of 20%, 7%, 7%, 7%, 5%, and 4%, respectively.[1]

Relatively few studies have reported on OZURDEXR implant desegmentation.[2],[3],[4],[5] These reports along with our case showed stable clinical course of the implant and did not lead to early or late intraocular complications.

In our case, despite the segmentation of the OZURDEXR implant, it showed a favorable anatomical and functional outcome. Physicians should pay close attention to the uncommon adverse events that may arise after or during the injection, and these patients might need close follow-up to monitor that complication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Haller JA, Bandello F, Belfort Jr R, Blumenkranz MS, Gillies M, Heier J, et al. Ozurdex Geneva Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 2010;117:1134-46. https://pubmed.ncbi.nlm.nih.gov/20417567/.  Back to cited text no. 1
    
2.
Agrawal R, Fernandez-Sanz G, Bala S, Addison PK. Desegmentation of Ozurdex implant in vitreous cavity: Report of two cases. Br J Ophthalmol 2014;98:961-3.  Back to cited text no. 2
    
3.
Rishi P, Mathur R, Rishi E. Fractured ozurdex implant in the vitreous cavity. Indian J Ophthalmol 2012;60:337-8.  Back to cited text no. 3
  [Full text]  
4.
Donmez O, Parlak M, Yaman A, Saatci AO. Splitting of a dexamethasone implant (Ozurdex) following the Injection. Case Rep Ophthalmol Med 2013;2013:247949.  Back to cited text no. 4
    
5.
Roy R, Hegde S. “Split Ozurdex implant: A caution.” Can J Ophthalmol 2013;48:E15-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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