Delayed Orbital Abscess Following Orbital Floor Reconstruction With a PLLA/HA Implant

Delayed abscess formation after orbital floor reconstruction using poly-L-lactic acid/hydroxyapatite (PLLA/HA) implants is exceedingly rare. A 49-year-old man presented with progressive diplopia and hyperglobus 4 years after orbital floor repair with a PLLA/HA implant. Imaging showed an encapsulated lesion displacing the globe with the implant appearing displaced within the lesion. Surgical exploration revealed a fibrous capsule containing purulent fluid and fragmented implant material. Staphylococcus epidermidis was cultured, and histopathology showed chronic inflammation and fibrosis. After complete removal of the implant and capsule, the patient experienced full resolution of diplopia and hyperglobus. This case highlights that late abscess formation can occur even with bioresorbable PLLA/HA implants, possibly related to degradation byproducts and systemic factors such as diabetes mellitus and smoking. Long-term follow-up and prompt surgical intervention are important for successful management.