Cystic roof collapse after intravitreal injection of dexamethasone implant, a case report

Introduction: Disorders of vitreoretinal interface represent a rare complication of intravitreal dexamethasone implant injection. Our report describes a new mechanism resulting in cystic roof collapse and emphasizes the importance of a strict optical coherence tomography evaluation during therapy with dexamethasone injection in order to prevent this rare complication. Purpose: To describe the rupture of the cystic roof following treatment with sustained-release dexamethasone implant intravitreal injection (Ozurdex; Allergan, Irvine) for macular edema. Case report: A 71-year-old woman with a known history of macular edema secondary to central retinal vein occlusion in her right eye presented to our ophthalmology department complaining of vision loss after she underwent the fourth dexamethasone injection. Diffuse retinal hemorrhages and a reddish foveal lesion with hyperpigmented borders were observed on dilated fundus examination. On the other hand, spectral domain optical coherence tomography (Spectralis HRA + OCT, Heidelberg Engineering, Germany) revealed the roof dismantlement of a previously documented cyst, giving rise to a lamellar macular hole, with a stable epiretinal membrane in close proximity. On a 12-month follow-up, no anatomical or functional changes were observed. Conclusion: This report depicts a new mechanism leading to macular hole as a complication of numerous intravitreal dexamethasone injections, resulting in cystic roof collapse. Although we acknowledge the rarity of this complication, our case emphasizes the role of constant spectral domain optical coherence tomography evaluation of the vitreoretinal interface, even in long-standing macular edema without marked signs of vitreous traction.