Anterior Chamber Migration of Dexamethasone Implant in a Patient Implanted with Carlevale Sutureless Scleral Fixation Intraocular Lens: A Case Report

Introduction: To report a case of anterior chamber migration of the dexamethasone intravitreal implant (DEX-I) through a new type of scleral fixated lens, the Carlevale® intraocular lens (IOL) (Cutting Edge, Italy). Case Presentation: A 74-year-old pseudophakic man with a history of macular edema (ME) secondary to retinal vein occlusion had been receiving DEX-I injections every 4 months for 10 years. During follow-up, he spontaneously presented an IOL luxation into the vitreous cavity, treated surgically with explantation and Carlevale® IOL implantation. One month after this surgery, an injection of DEX-I was performed, due to recurrence of the ME. Seven days after, the patient presented DEX-I migration into the anterior chamber along with corneal edema, requiring implant removal. After aspiration through a 20-gauge catheter connected to a syringe corneal edema decreased in 7 days allowing an improvement in visual acuity. Conclusion: Migration of the DEX-I into the anterior chamber remains a potential complication in vitrectomized eyes with capsular defects, even with the use of scleral-fixated IOLs such as the Carlevale®, which features a large optic. This highlights the importance of careful patient selection and postoperative monitoring in such cases.