Central Exudative Retinal Detachment: A Rare Complication after Intravitreal Dexamethasone Injection

A 67-year-old pseudophakic diabetic patient was treated for diabetic macular oedema and severe non-proliferative diabetic retinopathy. Macular optical coherence tomography (M-OCT; Heidelberg Spectralis OCT, Heidelberg, Germany) and fluorescence angiography confirmed the diagnosis. A pan-retinal Argon laser coagulation was performed between 2014 and 2015, and the macular oedema was treated with intravitreal injections (IVIs) in both eyes in our outpatient clinic since 2014. The left eye showed little to no improvement after six ranibizumab IVIs. A switch to Aflibercept was conducted, and – after six IVIs – the M-OCT showed no oedema anymore. The therapy could be paused, and the left eye further observed.

The right eye was first treated with 21 Aflibercept IVIs between 2014 and 2020, each time leading to an improvement and a reduction of the central retinal thickness followed by a worsening after 5 to 6 weeks. After 4 years of intravitreal anti-vascular endothelial growth factor treatment, no more macular oedema regression was observed. After careful examination of any potential contraindication and a detailed conversation with the patient, it was decided to switch the therapy to a sustained-release 0.7 mg dexamethasone intravitreal implant (Ozurdex). After each Ozurdex IVI, an improvement of the oedema was seen in the M-OCT. Best-corrected visual acuity (BCVA) initially remained stable at 0.30 logMAR under therapy. Ten weeks after the 6th IVI, the M-OCT examination is shown ([Fig. 1]).

Publication History

Received: 01 April 2022

Accepted: 22 June 2022

Article published online:
09 September 2022

• References

• 1 Georgalas I, Petrou P, Pagoulatos D. et al. Central serous chorioretinopathy in the fellow eye as a complication of intravitreal dexamethasone implant for the treatment of Irvine Gass syndrome. Clin Exp Optom 2016; 99: 601-603
• 2 Eris E, Erdogan G, Perente I. et al. A new side effect of intravitreal dexamethasone implant (Ozurdex^®). Case Rep Ophthalmol Med 2017; 2017: 6369085
• 3 Noh GM, Nam KY, Lee SU. et al. Central serous chorioretinopathy following intravitreal dexamethasone implant. Korean J Ophthalmol 2019; 33: 392-394
• 4 Liew G, Quin G, Gillies M. et al. Central serous chorioretinopathy: a review of epidemiology and pathophysiology. Clin Experiment Ophthalmol 2013; 41: 201-214
• 5 Chang-Lin JE, Attar M, Acheampong AA. et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Invest Ophthalmol Vis Sci 2011; 52: 80-86
• 6 Abdin AD, Suffo S, Fries FN. et al. Uniform classification of the pachychoroid spectrum disorders. Ophthalmologe 2021; 118: 865-878
• 7 Malclès A, Dot C, Voirin N. et al. Safety of Intravitreal Dexamethasone Implant (Ozurdex): The SAFODEX Study, Incidence and Risk Factors of Ocular Hypertension. Retina 2017; 37: 1352-1359
• 8 Fraenkel D, Suffo S, Langenbucher A. et al. Eplerenone for treatment of chronic central serous chorioretinopathy. Eur J Ophthalmol 2021; 31: 1885-1891
• 9 Bousquet E, Dhundass M, Lejoyeux R. et al. Predictive Factors of Response to Mineralocorticoid Receptor Antagonists in Nonresolving Central Serous Chorioretinopathy. Am J Ophthalmol 2019; 198: 80-87