Panophthalmitis and necrotizing fasciitis following glaucoma drainage device surgery: A case report

Post-surgical panophthalmitis and necrotizing fasciitis are rare but potentially sight- and life-threatening complications requiring urgent treatment. We report a case of invasive Group A Streptococcus infection following combined cataract and Ahmed Glaucoma Valve implantation surgery.

A 69-year-old man with advanced neovascular glaucoma, diabetes, hypertension, and atrial fibrillation underwent uneventful cataract surgery with intraocular lens placement and glaucoma drainage device implantation using a donor scleral patch. On postoperative day (POD) zero, the graft was adherent with intact conjunctival closure. By POD4, he presented with fever, confusion, orbital pain, swelling, chemosis, and purulent discharge, and was found to be in septic shock. Imaging showed exophthalmos, periocular swelling, fat stranding, and lateral rectus thickening. Examination revealed light perception vision, relative afferent pupillary defect, hypopyon, and vitreous haze. Blood and conjunctival cultures grew Group A Streptococcus. Despite intravenous and topical antibiotics, infection progressed. He underwent device explantation and subsequent enucleation with silicone implant, partial dacryoadenectomy, conformer placement, and temporary tarsorrhaphy. Orbital healing was satisfactory with resolution of infection and pain. Hospital course was complicated by aspiration pneumonia, Clostridium difficile colitis, and type two myocardial infarction with new heart failure. Although infection improved after a two-week course of antibiotics, the patient later suffered cardiac arrest and passed away.

This case documents exogenous panophthalmitis and necrotizing fasciitis following glaucoma drainage device implantation caused by invasive Group A Streptococcus. The case highlights the aggressive nature of infection and underscores the importance of early recognition, aggressive management, and careful postoperative monitoring in high-risk patients.