a 72-year - old patient who had undergone bilateral uneventful cataract surgery 6 years ago , presented with visual loss in her left eye .
patient had a medical history of multiple intravitreal and periocular steroid injections for the treatment of recalcitrant uveitis that was diagnosed 21 years ago .
her visual acuity decreased to hand motion in left eye , and slit - lamp biomicroscopy revealed in - the - bag iol with an intact posterior capsule , and severe flare in the anterior chamber .
an unclear image of macular edema was hardly detected on flourescein angiography ( fa ) that revealed flue images of posterior - segment obscured by media opacity .
after obtaining a signed informed consent , we scheduled to perform the intravitreal ozurdex application under the sterile conditions of the operation room .
a drop of 0.5% topical proparacaine hydrochloride with a drop of 5% povidone iodine was installed before the patient underwent an uncomplicated intravitreal dexamethasone implant application .
after significant regression of inflammatory cells secondary to uveitis , mild macular edema and an epiretinal membrane were precisely demonstrated with both optical coherence tomography and fa at 2 weeks after ozurdex application . on the postoperative 5 week , best corrected visual acuity ( bcva ) was improved to 0.4 logmar , and slit - lamp examination revealed the implant mislocated just behind the iol in an intact capsular bag , although there was no reaction in the anterior chamber , and no corneal edema was observed [ fig
it was thought that such implant anteriorly migrated toward into the posterior chamber through weak zonules in the present case as she had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber iol .
slit - lamp biomicroscopy revealed the dexamethasone implant mislocated just behind the intraocular lens in an intact capsular bag , and localized in the lower center of the visual axis ( white arrow ) any repositioning procedure was not considered since no sign of corneal edema or iop rise was present , as well as patient did not have any complaints although dexamethasone implant mislocated in the lower center of the visual axis .
close follow - up was scheduled for the case in order to find out any signs of anterior segment pathology . in the affected eye ,
bcva and iop were found as 0.5 logmar and 17 mmhg with a quiescent anterior chamber and a clear cornea at the 4 month of postoperative follow - up , besides dexamethasone implant completely degraded .
steroid - induced ocular complications such as cataract formation and iop elevation have been more commonly reported according to the accelerating ozurdex application in the treatment of macular edema .
anterior migration of dexamethasone implant has also been published as a rare complication in the literature .
migration of ozurdex into the anterior chamber was firstly described by pardo - lpez et al . in a patient with iris fixated iol .
after the patient had been referred with blurred vision in his left eye at the postoperative 3 week , authors noticed anterior migration of the implant with a diffuse corneal edema .
patient had to be undergone corneal transplantation since corneal edema did not resolve even though surgical removal of the implant from the anterior chamber was performed .
jonas and schmidbauer reported dislocation of a steroid implant into the anterior chamber in an aphakic vitrectomized eye .
vela et al . also reported the migration of ozurdex into the anterior chamber in a patient who previously underwent cataract surgery with iris - claw iol implantation .
the anterior migration of the ozurdex implant can cause complications such as secondary corneal decompensation . in these cases ,
bansal et al . published the migration of the implant into the anterior chamber in three noninfectious posterior uveitic eyes with the history of postlensectomy - vitrectomy aphakia .
authors reported that the implant was relocated in the vitreous cavity in two of the cases .
nonsurgical management of a dislocated dexamethasone implant into the anterior chamber with supine positioning after pharmacologic pupillary dilation was described by kishore and schaal .
published the scleral fixation of dexamethasone intravitreal implant with 10 - 0 nonabsorbable polypropylene suture in an angle - supported iol implanted case in order to prevent the risk of anterior segment complications associated with the migration of such implant into the anterior chamber .
it was recommended that dexamethasone implant which migrated into the anterior chamber ought to be removed as soon as possible in cases with incipient corneal edema .
on the other hand , no corneal edema was reported in patients with late migration of such intravitreally injected implant .
mentioned that only the patients in whom dexamethasone implant anteriorly migrated into the anterior chamber within 3 weeks after the intravitreal application developed corneal edema in their series .
any sign of corneal edema also did not occur in our case who was faced with the anterior migration of such implant 5 weeks after the uncomplicated intravitreal application .
anterior migration of a dexamethasone implant in eyes without perfect zonular or the posterior capsular integrity after cataract surgery , and with a history of the prior vitrectomy has been well - defined .
reported five patients with an anteriorly migrated dexamethasone implant despite within the same lens and capsular status , although they had previous uncomplicated dexamethasone implant injections without any anterior chamber migration .
anterior migration of a dexamethasone posterior implant into the anterior chamber through weak zonules was also described in cases with intact posterior capsule .
implant was surgically removed from the anterior chamber immediately by daudin and brzin , however turaka et al . reported that , without any surgical intervention , implant was spontaneously relocated back into the vitreous cavity with significant resolution of the corneal edema .
herein , we report the first case with anterior migration of a dexamethasone intravitreal implant that mislocated just behind the iol in an intact capsular bag . in the present case ,
the migrated implant was well tolerated as there was no sign of the corneal complication , iop rise , and anterior chamber reaction .
as this is a report of unique case with short follow - up , it is very difficult to comment that mislocation of a dexamethasone intravitreal implant on an intact posterior capsule is an innocent complication .
it is mandatory to observe more cases with long follow - up in order to estimate possible side effects of ozurdex implant attached on the posterior capsule .
 intravitreal application of ozurdex ( allergan , inc . , irvine , ca , usa ) which is a biodegradable , 
 sustained - release dexamethasone implant has been reported to be effective in the treatment of macular edema . 
 migration of such implant into the anterior chamber has been recently described in cases without perfect zonular or the posterior capsular integrity . 
 herein , we report the first case with anterior migration of ozurdex implant that mislocated just behind the intraocular lens ( iol ) in an intact capsular bag . 
 it is thought that such implant migrated anteriorly towards into the posterior chamber through weak zonules as the present case had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber iol . 
 however , the migrated implant was well tolerated since there was no sign of the corneal complication , rise in intraocular pressure , and anterior chamber reaction . 
 close follow - up was scheduled to find out any signs of anterior segment pathology . 
 meanwhile dexamethasone implant completely degraded at the 4th month of postoperative follow - up . 