Scleral fixation of fluocinolone acetonide implant
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A 68-year-old woman with a longstanding history of NIDDM, severe NPDR, persistent DME, and multiple injections of anti-VEGF drugs including bevacizumab and aflibercept underwent intravitreal injection of FAc implant OU. Past ocular history was notable for PCIOL, posterior capsulotomy, and epiretinal membrane. At baseline, VA was 20/100, and OCT demonstrated a CMT of 537 m. Two months after the FAc injection the patient described intermittent episodes of bar-like floater and blurring of vision. The VA was 20/80 and CMT had decreased to 480 m. Funduscopy showed the implant was floating within the inferior vitreous cavity. Five months following the FAc injection, VA was 20/80, persistent DME with CMT of 465 m, and ERM were present. In view of the persistent DME, presence of ERM, pseudophakia with open capsule, and a free-floating implant, the patient underwent 23G PPV, stripping of ERM, with scleral fixation of the FAc implant. At 2 months follow up, VA was 20/80, ERM had improved, and CMT had improved to 400 m.

Surgical technique
A 23G PPV approach, using 25 G MaxGrip forceps , was utilized to retrieve and externalize the FAc implant from the posterior segment in both cases. The suture was tied around the FAc implant by making 2 loops around the central part of the implant followed by 3/2/1 knots. This was repeated once more, the supratemporal sclerotomy cannula was removed and the implant was gently inserted through the pre-existing sclerotomy while ensuring the integrity of the supporting suture. Once the implant was completely introduced into the vitreous cavity, the supporting suture was gently pulled back allowing a slack of approximately 1 mm. The suture was subsequently secured to the sclera while closing the sclerotomy at the same time. The position and stability of the implant were confirmed by scleral-depressed visualization.

Source: https://www.sciencedirect.com/science/article/pii/S2451993620301225
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