Handling of dropped drug delivery devices

Hermann O.C. Gümbel (Ulm)

Purpose: In this paper we want to demonstrate how to handle intraocular devices, which are dropped in the vitreous cavity and rested on the posterior pole.
Patients and Methods: Two patients with a 10 year history of CMV retinitis and AIDS complain about a reduction of the visual acuity in one eye each. One of the patients did show a dropped ganciclovir implant on the macula, the other patient did show a epiretinal membrane and a pendling strut of the ganciclovir implant during pars plana vitrectomy. In a video we demonstrate how to remove the dropped implants and we demonstrate the follow up by OCT and visual function.
Results: The handling of dropped intravitreal implants is not a easy business and results in a deteriorating visual acuity. The use of 9.0 nylon sutures could be responsible for the crash of the implants out of the pars plana,
so it is more safe to use 8.0 Polypropylene sutures to fix fluocinolon implants of less weight in the pars plana.
Conclusion: Fixation of intraocular implants must be a safe procedure using the right sutures. Dropped implants always result in a bad visual acuity resulting from a cystoid macular edema and the patients are asked
for long acting antiinflammatory therapy including intravitreal triamcinolon.



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