Modified insertion technique for a sustained-release dexamethasone intravitreal implant (Ozurdex®)

Purpose We describe a modified injection technique that adheres a sustained-release dexamethasone intravitreal implant (Ozurdex®) to the vitreous base. Observations This modified technique was applied after removal of a prior dislocated Ozurdex® that migrated into the anterior chamber in one patient, and also on another patient bothered by perception of a large floater induced by a free-floating Ozurdex® in the vitreous cavity previously inserted with the conventional technique. The main feature of this new technique consisted of altering the conventional “bevel-up” orientation of the insertion needle tip towards the vitreous cavity to the modified “bevel-down” orientation of the needle tip directed towards the pars plana and vitreous base, for the purpose of adhering a portion of or the entire dexamethasone implant to the vitreous base. Neither patient developed postoperative complications with this technique. Conclusions and importance This modified insertion technique allows adherence of Ozurdex® to the vitreous base and avoids adverse effects associated with a free-floating Ozurdex®, such as its migration into the anterior chamber, or visual disturbance associated with movement of the implant.
Highlights • For conventional injection of sustained-release dexamethasone implant (Ozurdex®), needle tip is maintained in bevel-up position (facing vitreous cavity) before its insertion and after subsequent insertion and intraocular implant release. • For modified technique, needle-tip is first directed in conventional bevel-up position before insertion and re-directed in bevel-down position towards eye-wall after insertion. • Alternatively, needle is already in bevel-down position before its insertion, and maintained in same position after insertion with subsequent release and adherence of implant at vitreous base.