Background/purpose: To report a case of dislodgement of an Iluvien (fluocinolone acetonide) intravitreal implant into the infusion cannula during pars plana vitrectomy for retinal detachment.
Methods: The patient's surgery was video recorded, and the medical notes were reviewed retrospectively.
Results: A patient developed a macula off retinal detachment over 1 year after intravitreal injection of Iluvien for diabetic maculopathy. The patient underwent pars plana vitrectomy, removal of implant, and successful retinal reattachment. Although we planned to remove the implant through a sclerostomy, we were not able to localize it after performing peripheral indented vitrectomy. As the intraocular pressure was fluctuating, we suspected that the implant might have dislodged into the infusion cannula. However, despite increasing the intraocular pressure to 60 mmHg and performing repeated fluid-air exchange, we could not eject the implant back into the vitreous cavity. Therefore, after completing the surgery safely, we flushed the infusion cannula with balanced salt solution and we found the implant.
Conclusion: Increasing the intraocular pressure and performing fluid-air exchange were not sufficient to eject the implant probably because of the strong surface adherence between the infusion cannula and the implant's coating material. We, therefore, recommend removing and flushing the infusion cannula if the implant cannot be localized in the eye. In addition, clinicians should be aware that a fluctuating intraocular pressure might be the first sign of a partially blocked infusion cannula by the implant.