Video Presentation

Bimanual removal of intact dexamethasone intravitreal implant in endophthalmitis context

Video Details

First Author: F.Dolz-Güerri SPAIN

Co Author(s):    I. Alarcon Valero   A. Martinez-Palmer                          

Abstract Details



Purpose:

To describe the surgical technique of non-eroded dexamethasone intravitreal implant removal in a patient with exogenous endophthalmitis. Dexamethasone intravitreal implant, which contains a biodegradable polymer matrix of Poly Lactic-co-Glycolic Acid, was removed in order to prevent it to become a pathogen reservoir.

Setting:

Department of Ophthalmology. Hospital de l’Esperança and Hospital del Mar – Parc de Salut Mar (Barcelona)

Methods:

65 year-old Caucasian female presented with “left eye pain” three days after a dexamethasone intravitreal implant injection in her left eye. Exogenous endophthalmitis was diagnosed and she was treated with an anterior chamber wash and intravitreal (vancomycin and ceftazidime) and topical (moxifloxacin) antibiotics. 23 Gauge vitrectomy and chandelier endoillumination were used. We captured dexamethasone implant with extrusion cannula with silicone tubing. Bimanual surgery was performed by indentation of the free trocar and introducing dexamethasone implant inside free trocar lumen. Infusion pressure maintained the implant inside the trocar lumen. We removed trocar valve and aspirate dexamethasone implant with the extrusion cannula.

Results:

Dexamethasone intravitreal implant was removed successfully.

Conclusions:

Although dexamethasone intravitreal implant is not intended to be removed, in certain cases this therapeutic approach may be needed. Recent dexamethasone intravitreal implant administration may difficult its fragmentation. Using this surgical technique allowed in this case complete removal of a dexamethasone intravitreal implant.

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