Choroidal Detachment Secondary to Scleral Wound Leak After Ozurdex® Implantation in an Eye With Previous Vitrectomy:...

Retinal vein occlusion (RVO) is a major cause of visual morbidity, and macular oedema secondary to RVO is increasingly managed with repeated dexamethasone intravitreal implant (Ozurdex^®) therapy, particularly in eyes with suboptimal response to anti-vascular endothelial growth factor (VEGF) agents. While its efficacy is well established, the long-term cumulative risk to scleral integrity is less well characterised, especially in post-vitrectomy eyes. We report a case of an 86-year-old woman with a history of pars plana vitrectomy and recurrent macular oedema from branch RVO, treated over several years with repeated Ozurdex implants, who developed acute hypotony and choroidal detachment due to a scleral wound leak shortly after injection. Five days after implantation, the patient developed sudden vision loss and ocular pain with an intraocular pressure of 3 mmHg. Examination showed a positive Seidel test at the supertemporal entry site, and ultrasound revealed a non-kissing serous choroidal detachment. Urgent transconjunctival scleral suturing sealed the leak, resulting in rapid resolution of hypotony and anatomical recovery. Visual acuity improved from hand movements to 6/18 within one week, with subsequent stabilisation of macular oedema. A later steroid-related intraocular pressure rise was managed medically. This case emphasises how repeated injections into the same quadrant, combined with prior vitrectomy and age-related scleral changes, may predispose to focal scleral weakening, impaired wound closure, and hypotony. Early detection through Seidel testing and prompt surgical repair are crucial to preventing sight-threatening complications. Preventive measures, particularly injection-site rotation, careful post-injection wound assessment, and lower thresholds for suturing in high-risk eyes, are vital in long-term Ozurdex management.