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Late infection of hydroxyapatite orbital implants
B H Sloan1, A A McNab, P McKelvie
1Orbital, Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Australia.
Australian and New Zealand Journal of Ophthalmology
|March 18, 1999
Summary
Hydroxyapatite orbital implants can develop late, chronic infections, even without obvious risk factors. These rare infections, often caused by Staphylococcus aureus, may necessitate implant removal.
Area of Science:
- Ophthalmology
- Biomaterials Science
- Infectious Disease
Background:
- Hydroxyapatite orbital implants are widely used for anophthalmic socket reconstruction.
- While generally safe, complications like exposure and minor issues can occur.
- Infection is considered rare due to fibrovascular ingrowth, potentially reducing extrusion risk.
Observation:
- This study reports three cases of late-onset, chronic low-grade infection associated with hydroxyapatite orbital implants.
- These infections occurred after seemingly uncomplicated surgeries, with minimal or unnoticed conjunctival defects.
- Clinical presentation included subtle conjunctival changes or exposure.
Findings:
- Cultures revealed Staphylococcus aureus in two of the three cases.
- All three patients required hydroxyapatite implant removal due to persistent infection.
- Histopathology showed a distinct pattern of vascularized tissue adjacent to abscess formation within the implant.
Implications:
- Chronic hydroxyapatite implant infections can manifest late, independent of significant surgical complications or risk factors.
- Infection may originate within avascular implant areas before conjunctival integrity is compromised.
- Early recognition and management are crucial for successful treatment of these rare but serious complications.