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In Vivo Cross-sectional Imaging of a Degrading Dexamethasone Intravitreal Implant That Became Attached to the Macula

Ji Ah Kim, MD1,2; Eun Ji Lee, MD2; Kyu Hyung Park, MD, PhD2; Se Joon Woo, MD, PhD2
[+] Author Affiliations
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
2Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
JAMA Ophthalmol. 2015;133(3):350-352. doi:10.1001/jamaophthalmol.2014.5153.
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Dexamethasone intravitreal implant (Ozurdex) is a rod-shaped biodegradable implant composed of polylactic co-glycolic acid (PLGA) and 0.7 mg of dexamethasone. It has been shown to be effective for macular edema due to uveitis, retinal vein occlusion, or diabetic retinopathy.1,2

Two cases of macular attachment of the dexamethasone implant have been reported in a silicone oil (SO)–filled eye3,4 without longitudinal follow-up. We report the first case, to our knowledge, of a dexamethasone implant attaching to the macula in a vitrectomized eye without SO, with images revealing the implant’s in vivo absorption pattern.

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Figure 1.
Images of the Dexamethasone Implant Attached to the Macula

A, Fundus photographs (left) and optical coherence tomographic scans (right) show the dexamethasone intravitreal implant attached to the macula (arrowheads). B, Three-dimensional reconstructions of optical coherence tomographic images show gradual volumetric decrease and fragmentation of the implant.

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Figure 2.
Changes in the Size of the Dexamethasone Implant and Central Macular Thickness After Injection of the Implant

The absorption rate of the dexamethasone intravitreal implant decreased exponentially: implant length in micrometers = 3323.6e−0.229(postinjection month); implant thickness in micrometers = 583.52e−0.335(postinjection month). Half-lives were 3.0 months for the implant length and 2.1 months for the implant thickness. The percentages indicate the ratio between implant size and original implant size.

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