Implant Extrusion in the Context of Endophthalmitis and Panophthalmitis—A Systematic Review
Author: Yousef Sefau
Base Hospital / Institution: Dalhousie University
ePoster presentation
Abstract ID: 25-159
Purpose
To evaluate orbital implant extrusion and exposure rates following eye removal surgery in patients with endophthalmitis or panophthalmitis, and to assess the impact of implant type and infectious etiology on extrusion risk.
Methods
A systematic search of MEDLINE, Embase, CINAHL, and Scopus was conducted for studies published from 1980 to 2024. Inclusion criteria were cohort studies involving patients with clinical endophthalmitis or panophthalmitis who underwent enucleation or evisceration with orbital implant placement and reported extrusion or exposure outcomes. Fourteen studies met inclusion criteria out of the 1089 studies which were screened by three reviewers.
Results
Implant extrusion or exposure was reported in 12 of 14 studies, with rates ranging from 0% to 53%. Non-porous implants, especially those made of silicone, were more frequently associated with extrusion, while porous implants—particularly hydroxyapatite—demonstrated lower complication rates and were not linked to extrusion in any study. Pseudomonas aeruginosa was the most commonly reported pathogen in cases of extrusion, followed by Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Time to extrusion ranged widely, with earlier events more frequently associated with virulent organisms.
Conclusion
Orbital implant extrusion in the context of endophthalmitis and panophthalmitis appears to be influenced by both pathogen type and implant material. Non-porous implants and infections with Pseudomonas aeruginosa appear to pose the greatest risk. While prophylaxis against pseudomonas and other virulent organisms has long been implemented, the use of porous implants may reduce extrusion rates and improve outcomes in infected sockets. Further prospective studies are warranted to reach definitive conclusions.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ernest | Chan | Dalhousie University |
| Musbah | Khalaff | |
| Ahsen | Hussain | Nova Scotia Health Authority / Dalhousie University |
