DOI: 10.1097/01.iop.0000186656.06936.dd

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Issn Print: 0740-9303

Publication Date: 2005/11/01


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Reply re: “Enucleation with primary implant for treatment of recalcitrant endophthalmitis and panophthalmitis”

Dale R. Meyer; Ari D. Abel

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We appreciated the comments of Dr. Konkal and coworkers regarding our study of primary implant placement at the time of enucleation for recalcitrant enophthalmitis and panophthalmitis.1 The purpose of our study was to determine if placement of a primary orbital implant at the time of enucleation was reasonable. Some previous studies have recommended a delayed secondary implant in such situations. The results of our study suggested that primary implant placement was a safe and cost-effective treatment strategy, provided there was no gross purulent orbital contamination at the time of enucleation. In particular, no patient in our study developed spread of infection (e.g., meningitis) postoperatively. Indeed, as we discussed in the paper, a review of the medical literature from the modern (antibiotic) era would suggest that the risk of central nervous system “spread” following enucleation is exceedingly small.
The indications, and the relative pros and cons of evisceration, continue to be debated, and a full discussion of this topic would be beyond the scope of this letter. As noted in our paper, we believe that evisceration is appropriate for many cases of enophthalmitis, and we also perform them. However, as also stated, we would urge caution in using evisceration for cases of more advanced panophthalmitis, particularly in cases with infectious sclerokeratitis, in which the structural integrity of the sclera may be compromised. Pseudomonas infection can be particularly problematic in this regard. Although Dr. Konkal and coworkers did not indicate in their letter whether they place an implant primarily at the time of evisceration for enophthalmitis, in a study of this topic by Dresner and Karesh, previously cited in our study, it was found that most patients did fine. However one patient with Pseudomonas aeruginosa infection, of 11 patients with endophthalmitis, had an implant exposure requiring additional treatment.2 We hope this discussion will be helpful to other surgeons caring for patients with recalcitrant enophthalmitis and panophthalmitis.

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