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Beitragstitel Fulminating orbital cellulitis after an uncomplicated cataract surgery
Autor:innen
  1. Maria E. Correa-Pérez University Hospital Virgen de la Victoria, University of Málaga, Spain Präsentierende:r
  2. Karla Chaloupka Universitätsspital Zürich
Präsentationsform ePoster
Themengebiete
  • Orbit / Lids / Lacrimal System
Abstract-Text Purpose
To describe a case of a fulminating dissemination of infection in the orbital cavity after an uncomplicated cataract surgery in an immunocompromised patient.

Clinical Case
We present the case of a woman with previous history of myelodysplastic syndrome with aplasia and pancytopenia. An uncomplicated cataract surgery under topical anesthesia was practiced in her left eye. A week later she developed systemic discomfort, fatigue, fever and left palpebral edema. When the patient came to us, she presented a severe palpebral edema, limitations in the motility, increased intraocular pressure and a conjunctival hyposphagma in the operated eye. The systemic study showed severe pancytopenia and neutropenia, Pseudomonas aeruginosa grew in the blood culture and the diagnosis of a left orbital cellulitis was confirmed. It evolved initially to a worsening of the general situation despite the maximum intravenous therapy. With the neutrophils improvement the orbital situation experienced a worsening and an orbital abscess was identified in the imaging studies. A surgery was then performed with no drainable material being found and the microbiological study showed again Pseudomonas aeruginosa. The eye developed to an endophthalmitis and corneal perforation, the surgical option being rejected due to her fragile systemic situation. With the continuous hematological and antibiotic therapy, after more than a month it was possible to control the systemic and ophthalmological situation. Nowadays a stable situation presents, with a self-sealing of the corneal perforation, no pain, and light perception as the visual function in that eye.

Discussion
The patients with neutropenia have more risk to develop infections caused by non-capsulated extracellular bacteria (like Pseudomonas aeruginosa), levaduriform and filamentous fungi. In our patient, we consider that a minimal trauma such as a small conjuctival laceration and hyposphagma was the entrance for the massive orbital and intraocular infection.

Conclusions
Infections are a frequent cause of morbidity and mortality in immunocompromised hosts, and the management of neutropenic patients is a clinical challenge. We must not forget to assess the systemic situation of our patients, even in the case of initially minimally invasive surgeries such as cataract surgery. An improvement of the systemic situation, prior to an elective intervention, is recommended when possible.