Management Of Anterior Chamber Dexamethasone Implant Migration In A Patient Undergoing Secondary Iol Implantation And Dmek Surgery For Aphakic Bullous Keratopathy

To present the management of graft failure due to migration of the dexamethasone implant to the anterior chamber. 

Department of Ophthalmology, University of Health Sciences, Bursa City Hospital, Bursa, Türkiye

A 67-year-old male patient, had an angle-supported anterior chamber intraocular lens (IOL) implanted in his right eye after cataract surgery 5 years ago and had this IOL removed due to the complaint of progressive loss of vision for 1 year. On examination visual acuity was hand movement in the right eye and 12/20 (Snellen) in the left eye. Biomicroscopic evaluation of the right eye revealed corneal decompensation, aphakia, nasal pterygium, miotic pupil, and 2 peripheral iridotomys. The pterygium tissue was excised, and the pupil was dilated using iris hooks. Scleral fixation IOL implanted with Yamane technique. DMEK was performed 2 months after secondary IOL implantation. Postoperative early corneal transparency was achieved, and visual acuity increased to 20/40. Retinal vein occlusion and macular edema were detected in the right eye of the patient whose vision decreased to 20/200 in the postoperative 4th month. 3 doses of intravitreal bevacizumab (1.25 mg/0.05 mL) were injected right eye, and intravitreal dexamethasone (Dex) was implanted when the macular edema did not resolve. In the patient who developed sudden blurring of vision 3 weeks later, it was observed that the implant migrated to the anterior chamber, and corneal thickening and decompensation developed. The Dex implant was surgically removed. Topical steroids, and 5% NaCl drops were administered for corneal decompensation. DMEK was required because of the incomplete recovery of corneal edema within 3 months.

Angle supported- anterior chamber IOLs cause corneal decompensation. In this case, the anterior chamber lens should be removed and IOL implantation should be performed with scleral fixation. It should be considered that the dexamethasone implant may migrate into the anterior chamber in patients with vitreous loss in previous surgeries and in patients with large peripheral iridotomy. DMEK surgery is the most preferred method today to restore corneal transparency.