Surgical preferences in the management of recalcitrant endophthalmitis

Abstract

ABSTRACTTo assess the practice patterns of current members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) in the treatment of medically refractive endophthalmitis (MRE). A 17-question survey included the procedure of choice for MRE, the preferred type of orbital implant, the timing of implant placement, and the incidence of postoperative complications. 107 ASOPRS members participated in the study. In the setting of MRE, 72% preferred evisceration versus 28% who preferred enucleation. Fifty-nine percent of responders preferred enucleation if the MRE extended to orbital tissues versus 27% who would eviscerate. Among those that would place an orbital implant at the initial surgery, 65% would do so during an enucleation and 58% would do so during an evisceration. If an orbital implant was placed at the initial surgery, 52% of responders preferred a silicone implant, while 17% preferred hydroxyapatite implant. A minority of responders (6%) reported “yes” to ever having infectious complications after primary enucleation, compared to 10% after primary evisceration. Overall, 12% of responders noted more frequent complications (other than infectious) when an enucleation was performed compared to 5% for eviscerations. Current opinions on the surgical management of MRE show a trend toward evisceration, with 65% of ASOPRS respondents placing an orbital implant at the time of an enucleation and 58% at the time of an evisceration. Enucleation was preferred when involvement of orbital tissues was apparent. Both evisceration and enucleation remain a viable treatment option for MRE. The most appropriate initial approach is best determined by careful patient selection and informed decision-making by the patient.