First Author: W.Andreatta UK
Co Author(s): I. Elaroud A. Mitra
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To report the first case of dislodgement of an Iluvien® (fluocinolone acetonide) intravitreal implant into the infusion cannula during pars plana vitrectomy for retinal detachment.
Tertiary eye centre in the UK.
The patient’s surgery was video recorded and the medical notes were reviewed retrospectively.
A patient developed a macula off retinal detachment over one year after intravitreal injection of Iluvien® for diabetic maculopathy. The patient underwent pars plana vitrectomy, removal of implant and successful retinal reattachment. Although we planned to remove the implant through a sclerostomy, we were not able to localise it after performing peripheral indented vitrectomy. As the intraocular pressure was fluctuating we suspected that the implant might have dislodged into the infusion cannula. However, despite increasing the intraocular pressure (IOP) to 60 mmHg and performing repeated fluid air exchange (FAX) we could not eject the implant back into the vitreous cavity. Therefore after completing the surgery safely, we flushed the infusion cannula with balanced salt solution and we found the implant.
To the best of our knowledge, this is the first case in the literature reporting the dislodgement of an Iluvien® intravitreal implant into the infusion cannula during vitrectomy. Increasing the IOP and performing FAX were not sufficient to eject the implant probably because of the strong surface adherence between the infusion cannula and the implant’s coating material. We therefore recommend removing and flushing the infusion cannula if the implant cannot be localised in the eye. In addition, clinicians should be aware that a fluctuating IOP might be the first sign of a partially blocked infusion cannula by the implant.