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October 2017

Retinal Indentation by a Dexamethasone Implant in a Gas-Filled Eye: Report of an Unusual Complication

Author Affiliations
  • 1Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
JAMA Ophthalmol. 2017;135(10):1125-1127. doi:10.1001/jamaophthalmol.2017.3276

We present a patient in whom a dexamethasone implant indented the macula after pars plana vitrectomy and instillation of sulfur hexafluoride, 30%, causing early retinal damage. The damage was subsequently reversed after surgical repositioning of the implant.

A woman in her 70s with pseudophakia and a history of chronic noninfectious bilateral uveitis and recurrent cystoid macular edema was being treated with serial injections of 0.7-mg dexamethasone intravitreal implants (Ozurdex; Allergan). Her best-corrected visual acuity was approximately 20/50 OD and 20/200 OS. Subsequent examination revealed the development of an epiretinal membrane in the right eye, for which she underwent a 23-gauge pars plana vitrectomy. Following removal of the epiretinal membrane and the internal limiting membrane, a dexamethasone implant was introduced intravitreally. The implant floated to the superior aspect of the macula. Because of suspicion of a macular hole following membrane peel, air-fluid exchange was performed, and the vitreous cavity was filled with sulfur hexafluoride, 30%. The patient was instructed to maintain a chin-down position.

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