Document Detail


Enucleation with primary implant insertion for treatment of recalcitrant endophthalmitis and panophthalmitis.
MedLine Citation:
PMID:  15942499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: A prevalent conception exists that a two-stage operation (i.e., primary enucleation or evisceration with delayed secondary orbital implant insertion) is necessary when enucleation is required for recalcitrant endophthalmitis or panophthalmitis. The purpose of this study was to assess the utility of single-stage enucleation and primary reconstruction in this setting. METHODS: In a retrospective interventional case series, 22 consecutive patients with advanced endophthalmitis or panophthalmitis refractory to prior medical treatment underwent enucleation and primary implant placement by a single surgeon between 1991 and 2001. Eleven patients received hydroxyapatite implants; 11 patients received silicone implants. All patients were treated during surgery with intravenous antibiotics. All patients were evaluated for persistent local or systemic infection, implant exposure, extrusion, and successful fitting of their prostheses. RESULTS: No cases of persistent orbital cellulitis or meningitis occurred in any of the patients. Two patients with silicone orbital implants had extrusions; one was successfully managed with a secondary dermis-fat graft, and another patient who refused additional treatment was allowed to heal by secondary intention after the implant was removed. None of the patients with hydroxyapatite orbital implants had complications. All patients (20/20) who elected to undergo prosthetic fitting were successfully fit with prostheses. One patient elected not to pursue prosthetic fitting. One patient died of unrelated causes before a prosthesis could be fit. There were no objective findings to preclude successful fitting in either case. CONCLUSIONS: This study suggests that enucleation with primary orbital reconstruction and implant insertion for recalcitrant, fulminant ocular infection is an acceptable and advantageous treatment strategy. The risks and expenses associated with two separate surgeries are decreased, hospitalization time is potentially reduced, and subsequent rehabilitation can be initiated in a more timely fashion.
Authors:
Ari D Abel; Dale R Meyer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Ophthalmic plastic and reconstructive surgery     Volume:  21     ISSN:  0740-9303     ISO Abbreviation:  Ophthal Plast Reconstr Surg     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-06-08     Completed Date:  2005-06-30     Revised Date:  2006-01-24    
Medline Journal Info:
Nlm Unique ID:  8508431     Medline TA:  Ophthal Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-6     Citation Subset:  IM    
Affiliation:
The Abel Center for Oculofacial Plastic Surgery, LLC, Newark, Delaware, USA. drabel@abelcenter.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Durapatite
Endophthalmitis / surgery*
Eye Enucleation*
Eye, Artificial
Female
Humans
Male
Middle Aged
Orbit / surgery*
Orbital Implants*
Panophthalmitis / surgery*
Postoperative Complications
Prosthesis Implantation / methods*
Recurrence
Retrospective Studies
Silicone Elastomers
Chemical
Reg. No./Substance:
0/Silicone Elastomers; 1306-06-5/Durapatite
Comments/Corrections
Comment In:
Ophthal Plast Reconstr Surg. 2005 Nov;21(6):475; author reply 475   [PMID:  16304542 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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