Enucleation with Primary Hydroxyapatite Implant in Treatment of Recalcitrant Endophthalmitis

The treatment of recalcitrant endophthalmitis by either evisceration or enucleation is still debatable. Evisceration with primary implant insertion or delayed primary wound closure has many problems. Primary implant insertion has a higher risk of implant infection or exposure, while the delayed wound closure technique causes tedious dressing changes and poor cost effectiveness of implant insertion as a separate operative procedure. Thus, in this study, we evaluate the appropriateness of enucleation with primary hydroxyapatite (HA) implant in the treatment of endophthalmitis. Ten cases of suppurative endophthalmitis admitted to National Taiwan University Hospital were collected from August 1995 to June 1997. All patients underwent enucleation with primary hydroxyapatite implant. Patients records including demographic data, sphere size, wrapping material, clinical outcome, complications, and follow-up interval were noted. All ten patients underwent successful surgery. Mild superior sulcus syndrome occurred in two patients. Implant exposure occurred in one patient 5 weeks postoperatively due to overly tight prosthesis. A HA implant of 20mm in diameter was used on all patients. Five patients had the HA implant wrapped with lyodura, four had a vicryl mesh wrapped implant and one had a scleral shell wrapped implant. All patients were followed clinically for their assessment of cosmetic results and motility of the prosthesis. Excluding the one patient with implant exposure, seven out of nine patients rated their cosmetic results to be good. As for the motility of the implant, five out of nine patients rated good while three rated fair. Patients suffering from endophthalmitis have already undergone tremendous psychological stress apart from the physical torment. Enucleation with immediate placement of HA implant reduces the agonizing experience of dressing changes and the need for implant insertion as a second surgery. Our results show that enucleation with immediate HA implant is a safe and effective alternative in treatment of recalcitrant endophthalmitis.