Intravitreal dexamethasone implants run the risk of migrating into the anterior chamber, potentially leading to corneal edema that could require corneal transplantation surgery, according to a study presented at the American Society of Retina Specialists annual meeting in New York. Researchers say their presentation represents the largest case series of intravitreal dexamethasone implant migration into the anterior chamber to date. In their research, 37.5% of cases needed corneal transplantation surgery.

Earlier presentation of this complication could improve visual outcomes for these patients, researchers report. Therefore, it is vital that surgeons educate patients on signs and symptoms associated with implant migration into the anterior chamber.

The retrospective case series examines the risk to patients of needing to undergo corneal transplantation surgery following intravitreal dexamethasone implant migration into the anterior chamber. The investigators documented patient demographics, clinical course, and visual outcomes. 


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They collected data for each case through the Canadian Retina Society Listserv and various sites in the US, including age, indication for injection, duration from detection to treatment, and type of intervention performed. 

A total of 32 cases of dexamethasone implant migration into the anterior chamber, all of which were pseudophakic, were included in the study. Patients had a mean age of 66.8±12.5 years, and the mean duration from implant injection to detection of migration was 19.4±14.5 days.

Corneal transplant surgery was required for 37.5% of patients due to nonresolving corneal edema. Duration to detection of migration from dexamethasone intravitreal implant injection was not significantly different between the group who required corneal transplant and those who did not (P =.283). Duration from symptom onset to surgery was significantly longer in patients who required corneal transplant compared with those who did not (P =.007).

The researchers found that those who required corneal transplant were more likely to have a final Snellen visual acuity at their most recent follow up of 20/200 or worse compared with those who did not undergo transplantation (66.6% vs 25.0%; P =.02).

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Betsch D, Gupta RR, Rohowetz L, et al. Dexamethasone intravitreal implant migration into the anterior chamber: case series and review of the literature. Poster presented at: The 40th annual meeting of the American Society of Retina Specialists; June 13-16, 2022; New York. Poster 502.