Scleral fixation of dexamethasone intravitreal implant (OZURDEX^®) in a case of angle-supported lens implantation

OZURDEX^® is a biodegradable drug delivery system which has been reported to be an effective treatment in cases of macular edema. However, migration of the implant into the anterior chamber with elevation of intraocular pressure and corneal decompensation might occur in some cases. We report a case of an 80-year-old male who underwent intravitreal scleral fixation of OZURDEX^® due to postoperative macular edema secondary to complicated cataract surgery. He had a previous angle-supported lens implantation with superior Nd:YAG laser iridotomy. During surgery, the dexamethasone implant was introduced into the vitreous cavity and sutured to the sclera using a 10-0 non-absorbable polypropylene suture to prevent the risk of anterior complications in case of migration into the anterior chamber. After 6 months of follow-up, the macular edema had disappeared completely, the drug delivery system was not observed in the posterior segment and best-corrected visual acuity improved from 20/125 to 20/40 (Snellen equivalent). Neither anterior nor posterior segment complications were reported during the follow-up period. Intravitreal scleral fixation of the OZURDEX^® to the pars plana could be recommended as an alternative technique to avoid anterior migration of the device in a patient with an anterior chamber intraocular lens, which may lead to corneal decompensation and increased intraocular pressure.