Iatrogenic subretinal injection of Ozurdex® implant and its effect on macular edema

Abstract

Purpose: The purpose of this study was to report a rare case of subretinal lodgement of Ozurdex® implant (Allergan Inc., Irvine, CA, USA) and its effect on macular edema in a case of central retinal vein occlusion (RVO). Methods: A rare complication of subretinal lodgement of Ozurdex® implant without retinal perforation was encountered in a case of RVO with intractable macular edema. As associated retinal perforation was not noted, no intervention was done. The patient was regularly followed up at 1 month, and the effect on macular edema and intraocular pressure was analyzed. Results: The corticosteroid pellets got disintegrated and totally absorbed with a subtle chorioretinal scar by the 3rd follow-up month without any intervention. Even though subretinal, it was capable of reducing macular edema by 181 microns at 1 month postinjection, and its effect started wearing off by 2 months. Discussion: Subretinal lodgement of Ozurdex® implant is rare and preventable, yet a potential complication of intravitreal implants which is now in vogue. We speculate a too acute angle of injection or incomplete insertion of the drug delivery system applicator (DDS) away from the limbus or perhaps less refined previous DDS applicator to be a cause for subretinal delivery of the implant. The early disintegration of implant occurred due to breach in structural integrity that caused loss of controlled drug release and rapid absorption. It reduced macular edema up to 2 months without elevating intraocular pressure. Conclusion: A more widespread application of any technology always portends a more significant risk for complications, and an ophthalmologist should be aware of this potential risk. Though subretinal, corticosteroid implant was capable of reducing macular edema by 181 microns by 1 month and its effect wore off by 2 months.

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