Endothelial keratoplasty for corneal decompensation leaded by a dexamethasone implant dislocation in anterior chamber

Abstract

Background: Dexamethasone intravitreal implant (DEX) largely showed his safety and efficacy for the treatment of cases of
macular edema. Even if uncommon, delivery dislocation in anterior chamber has been described in Literaure as complication of the
injection procedure, leading to irreversible endothelial cell loss in the majority of cases.
We report a case of a 66-year-old man with pain and vision loss in his left eye. The anamnesis revealed a recent intravitreal
injection of DEX implant for a persistent cystoid macular edema related to central retinal vein occlusion. Anterior segment
examination showed corneal edema and the rod implant adherent to corneal endothelium. A large peripheral iridectomy was
evident with retroillumination and IOL appeared good centered in the bag. The implant was removed but corneal decompensation
was irreversible. One month later, an endothelial keratoplasty was successfully performed restoring corneal transparency.
DEX intravitreal implant can migrate from vitreous cavity to anterior chamber and lead to irreversible corneal decompensation by
mechanical and chemical toxicity on corneal endothelium. Removeal of the implant is necessary to avoid total endothelial
decompensation. Despite this, in some cases endothelial keratoplasty had to be performed.