DISLODGEMENT OF FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT INTO THE INFUSION CANNULA DURING VITRECTOMY FOR RETINAL DETACHMENT.
Journal
Retinal cases & brief reports
ISSN: 1937-1578
Titre abrégé: Retin Cases Brief Rep
Pays: United States
ID NLM: 101298744
Informations de publication
Date de publication:
2020
2020
Historique:
pubmed:
7
12
2017
medline:
22
4
2021
entrez:
7
12
2017
Statut:
ppublish
Résumé
To report a case of dislodgement of an Iluvien (fluocinolone acetonide) intravitreal implant into the infusion cannula during pars plana vitrectomy for retinal detachment. The patient's surgery was video recorded, and the medical notes were reviewed retrospectively. A patient developed a macula off retinal detachment over 1 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 localize 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 to 60 mmHg and performing repeated fluid-air exchange, 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. Increasing the intraocular pressure and performing fluid-air exchange 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 localized in the eye. In addition, clinicians should be aware that a fluctuating intraocular pressure might be the first sign of a partially blocked infusion cannula by the implant.
Sections du résumé
BACKGROUND/PURPOSE
OBJECTIVE
To report a case of dislodgement of an Iluvien (fluocinolone acetonide) intravitreal implant into the infusion cannula during pars plana vitrectomy for retinal detachment.
METHODS
METHODS
The patient's surgery was video recorded, and the medical notes were reviewed retrospectively.
RESULTS
RESULTS
A patient developed a macula off retinal detachment over 1 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 localize 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 to 60 mmHg and performing repeated fluid-air exchange, 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.
CONCLUSION
CONCLUSIONS
Increasing the intraocular pressure and performing fluid-air exchange 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 localized in the eye. In addition, clinicians should be aware that a fluctuating intraocular pressure might be the first sign of a partially blocked infusion cannula by the implant.
Identifiants
pubmed: 29210960
doi: 10.1097/ICB.0000000000000678
pii: 01271216-202001430-00002
doi:
Substances chimiques
Drug Implants
0
Glucocorticoids
0
Fluocinolone Acetonide
0CD5FD6S2M
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
215-217Références
Campochiaro PA, Brown DM, Pearson A, et al.; FAME Study Group. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology 2011;118:626–635.
Pavesio C, Zierhut M, Bairi K, et al.; Fluocinolone Acetonide Study Group. Evaluation of an intravitreal fluocinolone acetonide implant versus standard systemic therapy in noninfectious posterior uveitis. Ophthalmology 2010;117:567–575.
Holbrook JT, Sugar EA, Burke AE, et al.; Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group. Dissociations of the fluocinolone acetonide implant: the multicenter uveitis steroid treatment (MUST) trial and follow-up study. Am J Ophthalmol 2016;164:29–36.
Jaffe GJ. Reimplantation of a fluocinolone acetonide sustained drug delivery implant for chronic uveitis. Am J Ophthalmol 2008;145:667–675.
Taban M, Lowder CY, Kaiser PK. Outcome of fluocinolone acetonide implant (retisert) reimplantation for chronic noninfectious posterior uveitis. Retina 2008;28:1280–1288.
Yeh S, Cebulla CM, Witherspoon SR, et al. Management of fluocinolone implant dissociation during implant exchange. Arch Ophthalmol 2009;127:1218–1221.
Holekamp NM, Thomas MA, Pearson A. The safety profile of long-term, high-dose intraocular corticosteroid delivery. Am J Ophthalmol 2005;139:421–428.
Shi H, Guo T, Liu PC, et al. Steroids as an adjunct for reducing the incidence of proliferative vitreoretinopathy after rhegmatogenous retinal detachment surgery: a systematic review and meta-analysis. Drug Des Devel Ther 2015;9:1393–1400.
Franklin AJ, Shah G, Walia H. Minimally invasive vitrectomy surgery using small-gauge instrumentation. Retin Physician 2014.
Buchwalter LP. Adhesion of polyimides to metal and ceramic surfaces: an overview. J Adhes Sci Technol 2013;4:697–721.
Guevara-Villarreal DA, Rodríguez-Valdés PJ. Posterior segment intraocular foreign body: extraction surgical techniques, timing, and indications for vitrectomy. J Ophthalmol 2016;2016:2034509.