Kang Hyunseung, Lee Min Woo, Byeon Suk Ho, Koh Hyoung Jun, Lee Sung Chul, Kim Min
Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, Republic of Korea.
Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 06273, 134 Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea, 135-270.
Graefes Arch Clin Exp Ophthalmol. 2017 Sep;255(9):1819-1825. doi: 10.1007/s00417-017-3705-y. Epub 2017 Jun 10.
Our purpose was to describe the clinical course, and individualized management approaches, of patients with migration of a dexamethasone implant into the anterior chamber.
This was a retrospective review of four patients with seven episodes of anterior chamber migration of a dexamethasone implant.
After 924 intravitreal dexamethasone injections, anterior migration of the implant occurred in four eyes of four patients (0.43%). All four eyes were pseudophakic: one eye had a posterior chamber intraocular lens in the capsular bag but in a post-laser posterior capsulotomy state, two eyes had a sulcus intraocular lens (IOL), and one eye had an iris-fixated retropupillary IOL. All eyes had a prior vitrectomy and no lens capsule. The time interval from injection to detection of the implant migration ranged from 2 to 6 weeks. Of the four eyes with corneal edema, only one eye required a corneal transplantation, although it was unclear whether the implant migration was the direct cause of the corneal decompensation because the patient had a history of bullous keratopathy resulting from an extended history of uveitis. All patients underwent surgical intervention: two patients with a repositioning procedure, and the other two patients with removal due to repeated episodes, although surgical removal was not always necessary to reverse the corneal complications.
In our study, not all patients required surgical removal of the implants. Repositioning the implant back into the vitreous cavity may be considered as an option in cases involving the first episode with no significant corneal endothelial decompensation. Considering potential anterior segment complications and the loss of drug effectiveness together, an individualized approach is recommended to obtain the best treatment outcomes and to minimize the risk of corneal complications.
我们的目的是描述地塞米松植入物迁移至前房的患者的临床病程及个体化管理方法。
这是一项对4例患者7次地塞米松植入物前房迁移事件的回顾性研究。
在924次玻璃体内注射地塞米松后，4例患者的4只眼发生了植入物前向迁移（0.43%）。所有4只眼均为人工晶状体眼：1只眼的后房型人工晶状体位于囊袋内，但处于激光后囊切开术后状态，2只眼有沟内人工晶状体，1只眼有虹膜固定的瞳孔后人工晶状体。所有眼均曾行玻璃体切除术且无晶状体囊。从注射到检测到植入物迁移的时间间隔为2至6周。在4只发生角膜水肿的眼中，仅1只眼需要进行角膜移植，不过尚不清楚植入物迁移是否为角膜失代偿的直接原因，因为该患者有因葡萄膜炎病史较长导致的大泡性角膜病变史。所有患者均接受了手术干预：2例患者进行了复位手术，另外2例患者因反复发生而进行了取出手术，尽管手术取出并非总是逆转角膜并发症所必需的。
在我们的研究中，并非所有患者都需要手术取出植入物。对于首次发生且无明显角膜内皮失代偿的病例，可考虑将植入物重新定位回玻璃体腔。综合考虑潜在的眼前段并发症和药物疗效丧失，建议采用个体化方法以获得最佳治疗效果并将角膜并发症风险降至最低。
