A case of orbital abscess following porous orbital implant infection

PURPOSE: We present a case of orbital abscess following porous orbital implant infection in a 73-year-old woman with rheumatoid arthritis. METHODS: Just one month after a seemingly uncomplicated enucleation and porous polyethylene (Medpor) orbital implant surgery, implant exposure developed with profuse pus discharge. The patient was unresponsive to implant removal and MRI confirmed the presence of an orbital pus pocket. Despite extirpation of the four rectus muscles, inflammatory granulation debridement and abscess drainage, another new pus pocket developed. RESULTS: After partial orbital exenteration, the wound finally healed well without any additional abscess formation. CONCLUSIONS: A patient who has risk factors for delayed wound healing must be examined thoroughly and extreme care such as exenteration must be taken if there is persistent infection.     

Hydroxyapatite orbital implant exposure in children.

PURPOSE: Hydroxyapatite orbital implants are buried implants that may be integrated into the overlying prosthesis after enucleation. We report problems encountered using these implants during a 14-year period in a pediatric population. METHODS: Retrospective analysis of a pediatric population from 1987 through 2001. RESULTS: Indications for enucleation (N = 19) included retinoblastoma (n =17), persistent hyperplastic primary vitreous (n =1), and painful blind eye (n =1). Conjunctival erosion (36.84%) and consequent implant exposure (15.70%) were the main problems identified in this study. There were no cases of orbital infection. Management included resuturing and scleral patching. CONCLUSION: Conjunctival erosion of hydroxyapatite implants contributed to significant morbidity in 19 children who underwent enucleation and hydroxyapatite orbital implant.     

义眼座外露的原因分析

目的　了解义眼座植入术后义眼座外露的原因,为预防和治疗提供依据。方法　回顾性分析34 例义眼座植入术后义眼座外露的原因。结果　发现Ⅰ期(12 例)和Ⅱ期(22 例)发生外露的平均时间为术后38.6 个月和7.8 个月。所有患者或多或少均存在排异反应。处理得当者,排异反应就不表现,处理欠妥者,义眼座外露机会就增多。结论　义眼座外露的原因主要与排异反应、术中固定不良、术后处理不当、感染和磨擦等因素有关     

Actinomyces infection in porous polyethylene orbital implant

Background: A 60-year-old patient developed actinomycotic inflammation within a porous polyethylene orbital implant which she received following enucleation. Methods: She had repeated conjunctival exposures with inflammation the primary implant was removed and replaced with another one. Results: The anterior two-thirds of the porous implant was infiltrated with numerous actinomycotic granules surrounded by polymorphonuclear cells and necrotic debris. The organisms were demonstrated with Gram stains on the histopathologic preparations and with scanning electron microscopy. Within the zones of inflammation, the polyethylene skeleton of the implant was extensively damaged. Conclusion: Actinomycetes have been described as causative organisms in conjunctivitis, blepharitis, canaliculitis, dacryocystitis and keratitis, but to the best of our knowledge actinomycotic involvement has never been reported in an infected porous orbital implant.     

Culture-proven Aspergillus fumigatus infection in a primary hydroxyapatite orbital implant

Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3-year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years previously is reported. Repeated attempts at covering the exposed implant failed. Eventually the implant was removed, and Aspergillus fumigatus was cultured from the explanted material. This is the second reported case of Aspergillus infection of a hydroxyapatite orbital implant, and the first case where fungal cultures were positive.     

Bioceramic orbital implant exposure repaired by a retroauricular myoperiosteal graft

A patient with a painful, blind eye underwent enucleation and bioceramic orbital implantation. The bio-ceramic implant was wrapped with polyglactin 910 mesh and anteriorly capped with a scleral patch graft. Because there was tension on the wound, a relaxing conjunctival incision on the fornix was performed. Implant exposure with a diameter of 9 mm occurred 4 months after surgery. The exposed bioceramic implant was successfully repaired by a retroauricular myoperiosteal graft. The graft contains myofibrovascularized tissue, provides durable and vascularized coverage of exposed implants, and only requires a nearby harvesting site. The exposure completely resolved without recurrence after 2 years of follow-up.     

改良羟基磷灰石义眼台植入术临床观察

目的:观察改良的羟基磷灰石义眼台植入术的疗效。方法:对32例改良的义眼台植入术,其中Ⅰ期18例,Ⅱ期14例,进行回顾性分析。结果:本组改良的羟基磷灰石义眼台植入术后,义眼活动度好,与健眼同步,无脱出、眼窝凹陷或上睑下垂;其中3例义眼台暴露,重新手术修补。结论:对严重的眼球破裂伤、无光感疼痛性眼球或萎缩眼球患者行改良的羟基磷灰石义眼台植入术,是一种较安全而有效的方法。     

Mycobacterium chelonae-Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation

We report a clear corneal wound infection occurring in a 74-year-old man caused by a member of the Mycobacterium chelonae-Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin and ciprofloxacin. Despite aggressive therapy, a full-thickness corneal perforation developed, requiring emergent cyanoacrylate glue to preserve ocular integrity. Both the difficulty and delays in obtaining a correct diagnosis led to severe ocular morbidity. Infectious lamellar keratitis limited to the clear cornea phacoemulsification incision is rare, but some unusual organisms such as atypical mycobacteria may be encountered.     

Free orbital fat graft to prevent porous polyethylene orbital implant exposure in patients with retinoblastoma

PURPOSE: To determine if porous polyethylene orbital implant (Medpor) exposure can be prevented in retinoblastoma patients when the implant is placed in combination with a free orbital fat graft over the anterior surface of the implant. METHODS: Free orbital fat grafts were performed after enucleation and Medpor implantation, and results were compared with patients who underwent conventional enucleation and Medpor implantation without an orbital fat graft. RESULTS: Although implant exposure occurred in 13 of 39 eyes (33.3%) that had conventional enucleation and Medpor implantation, exposure did not develop in any of the 38 eyes that had the combined procedure with a free orbital fat graft. CONCLUSIONS: These findings suggest that a free orbital fat graft is a simple, effective way to prevent orbital implant exposure in patients requiring enucleation and Medpor implantation.     

Mycobacterium fortuitum infection masquerading as an orbital mass

Orbital infection with nontuberculous mycobacteria is rare and usually presents as an inflammatory process. We report a case of a 34-year-old male hospital worker with a positive purified protein derivative skin test who had Mycobacterium fortuitum infection that presented as an orbital mass causing diplopia. This presentation is unlike previously published reports and demonstrates the importance of orbital biopsy and tissue culture.     

Pyogenic granuloma as a presenting sign of hydroxyapatite orbital implant exposure: a clinicopathologic study

PURPOSE: We report 5 unusual cases of exposed hydroxyapatite orbital implants that presented as pyogenic granulomas. We propose pathogenesis and histopathologic correlations. METHODS: A clinicopathologic study of 5 patients with hydroxyapatite implants who presented with pyogenic granuloma. RESULTS: Pyogenic granulomas were detected 1.5 to 30 months after implantation in 5 patients. The lesions were multiple but were not related to the wound margin at the exposed area and were not covered by the surface epithelium in most instances. Exposure defects were detected in all patients at the time of lesion excision. The mean exposure size in the greatest dimension was 16 mm (range, 9-20 mm). Three patients were treated successfully with simple excision of the granulomas, burring down of the anterior surface of the implants, and direct repair of the exposure defects. Explantation of the implant was performed in 2 cases. Histopathologic examination revealed chronic inflammation and microabscess formation in the explanted implants. CONCLUSIONS: Five patients with pyogenic granulomas were found to have hydroxyapatite exposure. Pyogenic granuloma should not be considered a benign lesion on a hydroxyapatite orbital implant, especially in recurrent cases. Ophthalmologists must be aware of the possibility of conjunctival dehiscence with hydroxyapatite-implant exposure beneath the lesion.     

Investigation of a bioresorbable orbital implant

PURPOSE: To analyze a new bioresorbable orbital implant (open-celled polylactic acid, also known as OPLA). METHODS: The implants were examined macroscopically, with chemical analysis (Fourier transform infrared spectroscopy), and microscopically with scanning electron microscopy. Animal implantation of OPLA implants was carried out in 9 adult male New Zealand albino rabbits. Implant vascularization was evaluated by histopathologic sectioning. RESULTS: The OPLA implant is porous and lightweight but fragile. Histopathologically it stimulated primarily a multinucleated giant cell granulomatous reaction with little fibrovascular ingrowth seen at 4 and 8 weeks. By 20 and 24 weeks, the implant was replaced predominantly by necrotic debris and peripheral giant cells. CONCLUSIONS: The OPLA implant is not an acceptable alternative to other currently available orbital implants.     

Abscessed porous polyethylene (Medpor) orbital implant: a case report

We report the evolution of clinical features of orbital implant infection in a 42-year-old man. Despite appropriate treatment recurrent conjunctival dehiscence could not be prevented. Explanation of the implant resulted in complete resolution of symptoms. Histopathological examination confirmed focal necrotising acute inflammation with the presence of colonies of the organism in the deep substance of the implant.