Abstract
Purpose :
To report a case of late orbital infection with aspergillus and multiple bacteria species nine months after orbital floor fracture repair using the Titan Medpor implant.
Methods :
Observational case report
Results :
A 40 year-old male with a non-contributory past medical and ocular history presented with diplopia and right-sided enophthalmos after sustaining trauma to the orbit. Examination was relevant for moderate limitation in downgaze and exophthalmometry readings of 19.5 mm on the right and 22 mm on the left. His exam was otherwise unremarkable. CT imaging revealed a right orbital floor fracture with herniation of orbital contents into the maxillary sinus. Surgical repair achieved proper coverage of the fracture edges by a Medpor Titan orbital implant, which is a sheet of titanium mesh embedded within a porous polyethylene matrix with a solid barrier surface facing the orbital contents. Post-operatively, he had full extraocular motility, resolution of his diplopia and enophthalmos, and equal exophthalmometry measurements at one day, one week, and two months. He returned to clinic on post-operative month nine with complaints of right eye gaze-evoked amaurosis on upgaze, intermittent diplopia, and a pressure sensation on upgaze. Exam revealed full extraocular motility, 1 mm of hyperglobus on the right, and exophthalmometry readings of 22.5 mm on the right and 22 mm on the left. CT imaging of the orbits with and without contrast demonstrated a malpositioned orbital implant with a peri-implant capsule and fluid collection. He underwent orbital implant removal with drainage of the fluid collection. Cultures revealed the presence of non-fumigatus Aspergillus, along with rare Staphylococcus epidermidis and Neisseria sicca.
Conclusions :
Our case presents two uncommon orbital pathologies. The first being the occurrence of late orbital infection in an immunocompetent patient with an otherwise uncomplicated recovery. The second is a culture-proven orbital infection with Aspergillus spp. after an orbital floor repair with a porous polyethylene comprised implant. Post-operative orbital infection with Aspergillus sp. has no clearly defined incidence, with only a few case reports describing the complication. We use this case to bring awareness to these rare occurrences and the need to have high suspicion of late-onset implant infection in patients with orbital signs after fracture repair.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.