A two-step approach for suprachoroidal delivery of dexamethasone implant using a custom-made injector

Suprachoroidal injection enables targeted posterior segment drug delivery with reduced anterior segment exposure. Off-label use of the dexamethasone implant (Ozurdex) via the suprachoroidal route may benefit patients with macular edema who have contraindications to intravitreal therapy. This article aims to introduce a two-step surgical technique for suprachoroidal Ozurdex injection and reports its feasibility and short-term outcomes in an illustrative case.

A custom‑made injector assembled from a 26‑gauge hypodermic needle and an intravenous catheter. The technique involves: (1) injection of 0.3mL sodium hyaluronate viscoelastic into the suprachoroidal space at 4.0 mm posterior to the limbus; (2) injection of the dexamethasone implant through the same site. The technique was performed in a 37‑year‑old pregnant woman at 24 weeks of gestation with vitreous hemorrhage and macular edema secondary to proliferative diabetic retinopathy in the left eye immediately following pars plana vitrectomy. Main outcomes included feasibility, safety, best‑corrected visual acuity (BCVA), intraocular pressure (IOP) and imaging findings on ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT).

The procedure was completed without intraoperative complications. UBM at postoperative week 1 confirmed Ozurdex within an anechoic suprachoroidal space, which resolved by week 12. BCVA improved from decimal 0.2 (Snellen 4/20) at baseline to 0.4 (20/50) at 12 weeks. IOP remained stable (21-23 mmHg), with no cataract progression or significant IOP elevation. OCT showed resolution of intraretinal cysts.

This two-step technique for suprachoroidal Ozurdex delivery using a custom‑made injector with viscoelastic pre‑injection is feasible and showed no major safety concerns in this case. It may provide an alternative delivery method for selected patients with non‑infectious macular edema who have relative contraindications to intravitreal anti‑vascular endothelial growth factor (VEGF) or corticosteroid injections. Further studies are needed to establish safety and efficacy.