Atypical acute inflammatory reaction after intravitreal dexamethasone implant: a case of sterile endophthalmitis

A case is presented of a 77-year-old woman with recurrent cystoid macular edema treated with intravitreal dexamethasone implants (Ozurdex®), who developed an acute and severe intraocular inflammatory reaction after the last administration. Clinical and imaging findings, together with negative microbiological cultures and favorable evolution under conservative medical treatment, were consistent with sterile endophthalmitis or implant-induced panuveitis. The implant showed an abnormal appearance-swollen and surrounded by vitreous condensations-suggesting possible structural alterations of the device or inadvertent contamination during injection, which could have triggered an immunologic or irritative reaction, among other mechanisms described in the literature. This case highlights the importance of recognizing atypical presentations of intraocular inflammation following Ozurdex®, differentiating them from infectious processes, and reporting such events to pharmacovigilance systems, given that this is an exceptional reaction with very few cases reported in the literature.