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Mathew W. MacCumber, MD, PhD; Scott Sadeghi, DO; Jack A. Cohen, MD; Thomas A. Deutsch, MD

Arch Ophthalmol. 1999;117:1250-1254.

Background  The ganciclovir implant (Vitrasert; Bausch & Lomb Inc, Claremont, Calif) has been a useful device in the management of cytomegalovirus retinitis. Seven months after placement, implant exchange is often considered. However, removal may be difficult and may result in vitreous hemorrhage or intraocular dislocation.

Objective  To describe a suture loop attached to the implant strut and left in the sub–Tenon space to aid in implant removal.

Methods  Twenty-five eyes of 17 patients received a ganciclovir implant with an 8-0 nylon suture loop left beneath the Tenon capsule and underwent at least 6 months of follow-up. Two of these eyes subsequently had a similarly modified ganciclovir implant placed at a separate site (inferonasally) with at least 6 additional months of follow-up. Six eyes of 3 patients had the implant removed as part of an exchange and underwent at least 4 months of follow-up.

Results  In the 25 eyes, there were no cases of endophthalmitis, wound leak, suture exposure, or other complications. At implant removal in the 6 eyes previously mentioned, the loop was used for traction on the implant and aided in localization of the implant strut. In these 6 eyes, there were no cases of retinal or choroidal detachment, visually significant vitreous hemorrhage, implant dislocation, or other complications.

Conclusion  A sub–Tenon capsule suture loop is well tolerated and can assist in ganciclovir implant removal.

From the Departments of Ophthalmology, Rush Medical College, Rush University (Drs MacCumber, Cohen, and Deutsch) and Chicago Osteopathic Hospitals and Medical Centers (Dr Sadeghi), Chicago, Ill. None of the authors has a proprietary interest in the methods or products mentioned in this article.

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