Abstract
Introduction. Intravitreal drug injections and implants are generally safe but do carry some risk, from both the procedure itself and adverse effects of the medications. We report a case of an eccentric macular hole after dexamethasone implant (Ozurdex®) administration. Ex vitro force testing was performed to evaluate dexamethasone implant injection force. Methods. Five dexamethasone implant (Ozurdex) applicators were placed 16 mm from a force plate and the force of the injected dexamethasone pellet was recorded in Newtons. Four dexamethasone implant applicators were placed 16 mm from a force plate in a basic saline solution and the force of the pellet was recorded. Results. Average maximum force in air was 0.77 N and 0.024 N in a basic saline solution (BSS). Conclusion. We present a case report of an eccentric macular hole after dexamethasone implant administration. We hypothesize a mechanical injury to the retina during insertion caused the macular hole. Force testing done in air demonstrated sufficient force from the pellet injection to cause retinal damage though injections done in BSS showed reduced forces.
Highlights
Intravitreal drug injections and implants are generally safe but do carry some risk, from both the procedure itself and adverse effects of the medications
The average force reading for the implant administration in air was 0.77 N with a standard deviation of 0.26
Vitreous traction from the implant procedure has been proposed as a mechanism creating central macular holes [1, 3]
Summary
Ozurdex is an extended-release dexamethasone implant injected intravitreally for the treatment of noninfectious uveitis and macular edema. As with other steroid therapies, elevated intraocular pressure and cataract progression are the most common adverse events. A patient is presented who developed an eccentric macular hole following dexamethasone pellet implantation. The patient was pseudophakic bilaterally and had a history of bilateral Fuch’s dystrophy with corneal edema for which he had received a left Descemet’s stripping automated endothelial keratoplasty (DSAEK). The patient developed left macular edema of unknown origin and was treated with intravitreal bevacizumab ×2. After poor response to intravitreal anti-VEGF injections, the patient traveled to Europe where he received a dexamethasone implant for the recalcitrant macular edema into the left eye. The hole was not causing visual symptoms and has been monitored without change since that time
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