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Ophthalmic Images
May 11, 2017

Inadvertent Subconjunctival Injection of a Dexamethasone Implant

Author Affiliations
  • 1Begin Military Hospital, Saint-Mande, France
JAMA Ophthalmol. 2017;135(5):e170106. doi:10.1001/jamaophthalmol.2017.0106

Delivery of a dexamethasone intravitreal implant (Ozurdex, Allergan) was planned for a man in his 60s with postsurgical cystoid macular edema. Best-corrected visual acuity was 20/60 OD and central subfield thickness was 553 μm. The injection was accidentally performed in the subconjonctival space (Figure, A). The device broke into 3 parts but it was not removed. Intraocular pressure did not exceed 17 mm Hg without treatment during a close follow-up, but 3 weeks later, the patient developed an endothelial decompensation. Best-corrected visual acuity dropped to 20/200 OD and the implant was surgically removed immediately. Best-corrected visual acuity was 20/60 OD with a clear cornea by 15 days after removal of the implant and a combination of dimethicone drops and hyperosmotic sodium chloride drops. Another dexamethasone intravitreal implant was given 45 days after removal of the implant (visual acuity, 20/60 OD; central subfield thickness, 485 μm) and macular edema was noted to have resolved by 7 days after implantation (visual acuity, 20/30 OD; central subfield thickness, 305 μm).

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