Anterior chamber migration of intravitreal dexamethasone implant (Ozurdex®) in pseudophakic eyes: report of three cases

Intravitreal implantation of Ozurdex(®) (Allergan Inc., Irvine, CA, USA) is being used widely for the treatment of macular edema secondary to retinal vein occlusion and in the setting of non-infectious posterior uveitis. We describe a complication little reported in the literature until now: migration of the dexamethasone implant into the anterior chamber. We report three cases of migration in two pseudophakic patients with iris claw lenses (on the anterior and posterior aspects of the iris) and in one pseudophakic patient with a posterior chamber IOL and zonular rupture. The risk of anterior chamber migration of the Ozurdex(®) implant is increased in cases of prior vitrectomy (three cases), prone positioning and dilation of the pupil (mydriasis). Clinical tolerability of the implant in the anterior chamber is poor in all cases, with diffuse corneal edema. Endothelial cell loss occurs, as demonstrated by specular microscopy performed in two of our patients. Removal or repositioning of the Ozurdex(®) implant into the posterior segment must be performed without delay because of the risk of endothelial toxicity. Patients without perfect zonular/posterior capsular integrity present a high risk of anterior chamber migration of the Ozurdex(®) implant. In such cases, anti-VEGF therapies should be discussed as an alternative.