Primary evisceration for neonatal endogenous endophthalmitis: A report of two cases

Abstract

Purpose: To present two cases of neonatal endophthalmitis with poor prognosis that were managed with primary evisceration.

Observations: Case 1 is a 27-weeks' gestation neonate who developed Pseudomonas aeruginosa endophthalmitis complicated by globe rupture. Case 2 describes a 34-weeks' gestation neonate with Serratia marcescens endophthalmitis. Both patients had poor prognosis and thus underwent primary evisceration with good long-term cosmetic outcomes at 15 years and 17 months, respectively.

Conclusions and importance: Primary evisceration should be considered in neonates with endophthalmitis with a poor prognosis and can result in good long-term cosmesis.

Keywords: Endophthalmitis; Evisceration; Oculoplastics; Retina.

Fig. 1

B-scan ultrasound of the right eye demonstrating dense infiltrates in the vitreous, choroid, and retina without evidence of shadowing.

Fig. 2

A-D: Gram stain of the evisceration specimen from the right eye demonstrated gram negative rods (box in A, enlarged in B). The retina demonstrated necrosis with inflammatory infiltrate (C). The vitreous also demonstrated inflammatory cell infiltrate (D).

Fig. 3

A-C: Fundus photos taken at baseline of the left eye (A: macula and B: temporal retina) demonstrate stage 2 retinopathy of prematurity with a temporal ridge in zone II (arrow in B). C: Fundus photography of the left eye taken 15 years later after laser treatment demonstrates regression of the retinopathy of prematurity including resolution of the temporal ridge and vascularization of the peripheral retina.

Fig. 4

A,B: External photograph of the right eye showing a well formed post-surgical socket 15 years after evisceration with implant removed (A) and with ocular prosthesis placed (B).

Fig. 5

A,B: External photograph of the left eye (A) of Case 2 on day 7 of life demonstrates periorbital edema, diffuse chemosis, hyperemia, and a dense yellow hypopyon filling the anterior chamber. B-scan ultrasound (B) reveals a dense vitreous opacity without shadowing. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 6

Fundus photography of the right eye demonstrates a normal fundus without retinopathy of prematurity or infection.

Fig. 7

A-C: Intraoperative photo at baseline demonstrates central corneal infiltration with surrounding corneal clouding of the left eye with suppuration (A). Follow up at 10 months (B) and 17 months (C) after evisceration of the left eye demonstrated good symmetry and brow and cheek projection.