Purpose

Primary placement of orbital implant in eyes undergoing evisceration because of an acute endophthalmitis remains controversial, because of the increased risk of implant exposure. Therefore, the main purpose of this study was to analyse the rates of prosthesis fitting after evisceration without orbital implant placement in the context of endophtalmitis.

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Methods

We retrospectively reviewed clinical charts of all patients who suffered from endophtalmitis and who underwent an evisceration without primary implantation between 2012 and 2025 at the Hospital Fondation Adolphe de Rothschild in Paris, France.

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Results

47 patients were included, with a mean age of 71.2 years (19-99) and a follow up of 37 months (1-138 months). Visual acuity at the first visit was no light perception in the majority of cases (62%), and the mean time from first consultation to surgery was 19.2 days. Panophtalmitis was associated in 63.8% of cases. Most of the endophtalmitis were secondary to corneal infection (79%). The most commonly identified germ was Pseudomonas Aeruginosa (29.8%), followed by streptococcus (17%).
The vast majority of the patients had a successful prosthesis fitting (80.1%). Of the 9 patients who had no fitting, there were only 2 patients who could not undergo rehabilitation, the remaining 7 just did not want to go through with it. 8 patients (17%) asked for a secondary surgery to achieve a better aesthetic outcome. 4 patients underwent secondary orbital implantation, of whom two had an exposure (one early at 6 months and the second one 9 years after the implantation). The four other patients underwent dermis fat graft surgery with good results.

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Conclusion

Managing evisceration in the context of endophthalmitis without orbital implantation achieves satisfactory outcomes, with only a few patients asking for a secondary surgery and a high rate of protosthesis rehabilitation. Management without implantation could avoid secondary surgery in elderly patients with comorbidities, and secondary dermis fat graft could be a good alternative to avoid implant exposure.

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Additional Authors

First name	Last name	Base Hospital / Institution
Marie	Callet	Hopital Fondation Rothschild
Mathieu	Zmuda	Hopital Fondation Rothschild
Edgard	Farah	Hopital Fondation Rothschild
Natasha	Mambour	Hopital Fondation Rothschild
Pierre-Vincent	Jacomet	Hopital Fondation Rothschild
Olivier	Galatoire	Hopital Fondation Rothschild

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