"Magic Bullet": Eccentric Macular Hole as a Complication from Dexamethasone Implant Insertion

Area of Science:

• Ophthalmology
• Retinal Surgery
• Ocular Pharmacology

Background:

• Intravitreal injections and implants are common ophthalmic procedures.
• While generally safe, these interventions carry risks, including procedural complications and drug-related adverse effects.
• A rare complication of eccentric macular hole formation has been observed post-injection.

Purpose of the Study:

• To report a case of eccentric macular hole following dexamethasone implant (Ozurdex®) administration.
• To investigate the ex vivo injection force of the dexamethasone implant.
• To evaluate the potential mechanical forces involved in implant delivery.

Main Methods:

• A case of eccentric macular hole after Ozurdex® implant is presented.
• Ex vivo force testing of five Ozurdex® applicators was conducted 16 mm from a force plate.
• Pellet injection force was measured in air and in basic saline solution (BSS).

Main Results:

• The average maximum injection force of the dexamethasone pellet in air was 0.77 N.
• The average maximum injection force in BSS was significantly lower, measuring 0.024 N.
• These findings suggest a potential for mechanical retinal injury during insertion.

Conclusions:

• Eccentric macular hole is a potential complication after dexamethasone implant administration.
• The study hypothesizes that mechanical retinal injury during insertion may cause the macular hole.
• Force testing indicates that the pellet's injection force in air is sufficient to cause retinal damage, while BSS reduces this force.