Implant extrusion after eye removal for endophthalmitis and panophthalmitis

To evaluate the rate of orbital implant extrusion and exposure following enucleation or evisceration in patients with endophthalmitis or panophthalmitis, and to assess the influence of infectious etiology, implant type, and surgical technique on extrusion risk.

A systematic review was conducted using MEDLINE, CINAHL, Embase, and Scopus for studies published between January 1980 and December 2024. Studies were included if they evaluated implant extrusion or exposure following eye removal surgery in patients diagnosed with endophthalmitis or panophthalmitis. Fourteen retrospective cohort studies met the inclusion criteria.

Extrusion or exposure rates ranged from 0% to 53%. Pseudomonas aeruginosa was the most frequently implicated pathogen. Non-porous implants, especially silicone, were more commonly associated with extrusion, while porous implants, particularly hydroxyapatite, demonstrated lower complication rates. No clear difference was observed between evisceration and enucleation in terms of extrusion risk.

Implant extrusion is a significant postoperative complication in the setting or endophthalmitis or panophthalmitis. Pseudomonas aeruginosa and the use of non-porous implants may increase extrusion risk. The use of porous implants and appropriate prophylactic antibiotics may be associated with lower risk of extrusion. Further prospective studies are required to standardize risk assessment and prevention strategies.