Anterior Chamber Migration of Intravitreal Dexamethasone Implant in an Eye with Scleral-fixated Intraocular Lens

A 60-year-old woman with diabetes and hypertension presented with a decreased vision OD to 6/18 N10 due to cystoid macular edema (CME) following vitrectomy for removal of the dislocated posterior chamber intraocular lens (PCIOL) and scleral-fixated intraocular lens (SFIOL) implantation performed five months before. Spectral domain optical coherence tomography (SD-OCT) showed a central foveal thickness (CFT) of 484 μm. Intravitreal ranibizumab (LUCENTIS®; Genentech, Inc) was administered; however, the CFT increased to 533 μm after one month. She received intravitreal dexamethasone (DEX) implant (Ozurdex®, Allergan Inc.), which resulted in best corrected visual acuity (BCVA) improvement to 6/12 N10 and CFT reduction to 404 μm within a month. Three months later, CFT increased again to 677 μm and she received a second DEX implant. Seven weeks following the injection, she presented with pain, corneal haze, and intraocular pressure (IOP) of 38 mmHg. A week later, IOP decreased to 16 mmHg on brimonidine tartrate 0.2% and timolol maleate 0.5% BD; however, the DEX implant was seen in the anterior chamber (Figure 1a). Complete pupillary dilatation in this vitrectomized eye allowed the implant to migrate forward through the gap between the IOL edge and the pupil.