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Purpose: To establish the prevalence and risk factors for intravitreal dexamethasone implant migration into the anterior chamber in eyes with macular edema., Methods: This was a multicenter, retrospective, observational chart review of data that included patients with macular edema who had been treated with at least one intravitreal dexamethasone injection. Patients with incomplete chart information during the follow-up period were excluded., Results: The prevalence of implant migration in 468 patients, considering the number of injections, was 1.6%, with significant associations between implant migration and cataract surgery (P = 0.043) and intraocular lens status (P = 0.005) and a trend toward statistical significance (P = 0.057) with vitrectomy. A higher rate of implant migration into the anterior chamber was observed in vitrectomized eyes (4.8%) when compared with patients who did not undergo a vitrectomy (1.6%). The implants that migrated were removed with forceps with/without viscoelastic expression or with 20-gauge cannulas connected to the vitreous cutter machine., Conclusion: The risk of implant migration into the anterior chamber was 1.6%. Risk factors were a history of cataract surgery or vitrectomy and aphakia. When anterior migration occurs, rapid removal is advised, especially if corneal edema is present.

Background and Objectives: Dorsal root ganglion stimulation is an emerging therapy in the treatment of chronic pain. Compared with traditional spinal cord stimulation, it allows a discretely targeted stimulation profile and may act via differing mechanisms of action. Despite these advantages, little is known about the complications associated with this new modality., Methods: We queried the MAUDE (Manufacturer and User Facility Device Experience) database for all entries named 'Dorsal root ganglion stimulator for pain relief' reported between May 1, 2016 and December 31, 2017. We verified these data through the Office of the Freedom of Information Act at the US Food and Drug Administration. We then eliminated duplicate entries and categorized each complication based on the event description. A secondary analysis was performed to characterize the serious adverse events and the severity of new neurologic symptoms and infections., Results: We identified 979 unique episodes following our process of deduplication. Almost half (47%) of entries were categorized as device-related complications, a quarter (28%) as procedural complications, with the remainder as patient complaints (12%), serious adverse events (2.4%), and 'other' complications (4.6%). The majority of complications were managed surgically with revision (n = 488; 49.8%) rather than explant (n = 161; 16.4%) events, respectively., Conclusions: The 'Dorsal root ganglion stimulator for pain relief' device has been publicized as a breakthrough in neuromodulation technologies. As with any new technology, we must proceed with caution and re-evaluate effectiveness as information becomes available. The MAUDE database has provided safety data unique for this device that will aid in informed consent and further refinement of this innovative therapy., Competing Interests: Competing interests: SPC has served as a consultant to Abbott in the past 3 years on the topic of radiofrequency ablation. All other authors declare no conflicts of interest., (© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The silicone breast implant controversy has amassed a great deal of media coverage in the past year. Unfortunately, separating fact from fiction has been extremely frustrating and difficult, not only for physicians but for women who have either had or are considering cosmetic or reconstructive surgery of the breast. At a recent meeting attended by most of the board eligible and certified Plastic and Reconstructive Surgeons in the State of Arkansas, it was felt that a consensus statement was needed to clarify the issues and inform other Arkansas physicians of the most up to date information. The result is a fairly comprehensive review which will require your indulgence. Breast implants are placed not only by Plastic and Reconstructive Surgeons, but by Otolaryngologists, "Facial Plastic Surgeons", Obstetricians/Gynecologists, General Surgeons, Dermatologists and Family Practitioners. We believe it is the ethical and legal responsibility of the physicians who elect to perform these procedures to provide adequate care and follow-up for these patients when either real or perceived problems arise. Accurate information, reassurance and occasionally re-operations are required for many of these patients.