Orbital Cellulitis Following Uncomplicated Aqueous Shunt Surgery

Abstract

We report that a more conservative approach (without tube removal) to be successful in a case where there is no evidence of tube exposure. It is important to appreciate that in some cases of orbital cellulitis without clear signs of intraocular involvement, a tube can be left in situ.

Orbital Cellulitis Following Uncomplicated Glaucoma Drainage Device Surgery: Case Report and Review of Literature

“…In seven cases, symptoms of OC started in the immediate postoperative period (≤ 3 months after the surgery). [1,2,[5][6][7][8] In the other four cases, OC developed after the postoperative month 3. [2][3][4]9] In three of the four cases of delayed-onset OC, [2,4,9] the tube was exposed, presumably serving as a conduit for bacteria to travel from the ocular surface into the orbit.…”

“…Most patients presented within two days of symptom onset. [1][2][3][4][5][6][7][8] On presentation, all patients had eyelid erythema and edema, and most patients had chemosis, proptosis or globe displacement, and limited extraocular motility.…”

“…The most common GDD associated with post-implantation OC was the Ahmed valve (n = 7), [2][3][4][5][6][7] although Molteno, [1] Krupin-Denver, [2] and Baerveldt [8,9] implants have also been associated with post-implantation OC. In seven cases, symptoms of OC started in the immediate postoperative period (≤ 3 months after the surgery).…”

“…Previous studies have shown that steroids can help reduce the cytokine load and improve outcomes in bacterial OC. [12,13] Goldfarb [7] Beck [8] Table 2.…”

“…[2][3][4][5]7] In three cases, there was a sufficient improvement with IV antibiotics alone; consequently, no surgical interventions were undertaken. [2,6,8] When IV antibiotics were transitioned to oral antibiotics, fluoroquinolones were most commonly used, [4,[7][8][9] likely owing to their vitreous penetration and relatively broad coverage. [14] The duration was most commonly 10 days, as seen in four cases.…”