Orbital Cellulitis Following Uncomplicated Glaucoma Drainage Device Surgery: Case Report and Review of Literature
Purpose: Orbital cellulitis (OC) is a rare postoperative complication of glaucoma drainage device (GDD) implantation. To date, there have only been 10 reported cases of OC following GDD implantation.
Case Report: Here, we report a case of OC in a 57-year-old man who developed pain, proptosis, and limited extraocular motility two days after uneventful Ahmed FP7 implantation in the right eye. Contrast-enhanced computed tomography of the orbits demonstrated fat stranding and a small fluid collection, consistent with OC. He had minimal improvement with intravenous antibiotics and ultimately underwent GDD explantation. A systematic review of the literature showed that the development of OC following GDD implantation can occur in the early or late postoperative period. Immediate hospitalization with intravenous administration of broad-spectrum antibiotics is recommended. Explantation of the infected GDD is often required for source control.
Conclusion: OC is a rare postoperative complication of GDD implantation. Prompt evaluation and treatment are required, often combined with GDD explantation.
Ahmed Tube Shunt, Orbital Cellulitis, Glaucoma Drainage Device
1. Karr DJ, Weinberger E, Mills RP. An unusual case of cellulitis associated with a Molteno implant in a 1-year-old child. J Pediatr Ophthalmol Strabismus 1990;27:107–10.
2. Chaudhry IA, Shamsi FA, Morales J. Orbital cellulitis following implantation of aqueous drainage devices. Eur J Ophthalmol 2007;17:136–140.
3. Kassam F, Lee BE, Damji KF. Concurrent endophthalmitis and orbital cellulitis in a child with congenital glaucoma and a glaucoma drainage device. Digit J Ophthalmol 2011;17:58–61.
4. Farid MF, Awad MA, Bella EA. Consensual orbital cellulitis and endophthalmitis complicating pediatric glaucoma drainage implant. Austin Ophthalmol 2016;1:1004.
5. Esporcatte BL, Teixeira LF, Rolim-de-Moura C. Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient. Arq Bras Oftalmol 2016;79:123–125.
6. Marcet MM, Woog JJ, Bellows AR, Mandeville JT, Maltzman JS, Khan J. Orbital complications after aqueous drainage device procedures. Ophthalmic Plast Reconstr Surg 2005;21:67–69.
7. Goldfarb J, Jivraj I, Yan D, DeAngelis D. A case of pseudomonas orbital cellulitis following glaucoma device implantation. J Glaucoma 2019;28:e14–16.
8. Beck DE, El-Assal KS, Doherty MD, Wride NK. Orbital cellulitis following uncomplicated aqueous shunt surgery. J Glaucoma 2017;26:e101–102.
9. Laviña AM, Creasy JL, Tsai JC. Orbital cellulitis as a late complication of glaucoma shunt implantation. Arch Ophthalmol 2002;120:849–851.
10. Tsirouki T, Dastiridou AI, Ibánez Flores N, Cerpa JC, Moschos MM, Brazitikos P, et al. Orbital cellulitis. Surv Ophthalmol 2018;63:534–553.
11. Asbell PA, Sanfilippo CM, Pillar CM, DeCory HH, Sahm DF, Morris TW. Antibiotic resistance among ocular pathogens in the United States: five-year results from the antibiotic resistance monitoring in ocular microorganisms (ARMOR) surveillance study. JAMA Ophthalmol 2015;133:1445–1454.
12. Fu SY, Su GW, McKinley SH, Yen MT. Cytokine expression in pediatric subperiosteal orbital abscesses. Can J Ophthalmol 2007;42:865–869.
13. Pushker N, Tejwani LK, Bajaj MS, Khurana S, Velpandian T, Chandra M. Role of oral corticosteroids in orbital cellulitis. Am J Ophthalmol 2013;156:178–183.
14. George JM, Fiscella R, Blair M, Rodvold K, Ulanski L, Stokes J, et al. Aqueous and vitreous penetration of linezolid and levofloxacin after oral administration. J Ocul Pharmacol Ther 2010;26:579–586.