Post-Operative Infection Following Strabismus Surgery: Case Series and Increased Incidence in a Single Large Referral Center
Robert J. House MD; Jill C. Rotruck MD; Laura B. Enyedi MD; David K. Wallace MD, MPH; Ezzeldin Saleh MD; Sharon F. Freedman MD
Duke Eye Center
Durham, North Carolina
Introduction: Infection following strabismus surgery is uncommon, with orbital infection reported in approximately 1/1100 and 1/1900 cases and possible infection occurring in 2.9% (46/1603). Our purpose was to identify patients with probable post-operative infection following strabismus surgery, and to report incidence, risk factors and outcomes.
Methods: We searched our database to identify strabismus procedures from 7/1996-10/2017 at one large referral center, defining clinical infection based on change in clinical management including systemic antibiotic use, hospitalization, and/or surgical intervention.
Results: Thirteen of ~9200 strabismus surgeries(0.0014%), met criteria for probable infection, all occurring since 10/2012 [0/6674 vs. 13/2558 before/after 10/2012, p<0.0001]. Mean age was 11.4 years, with 11/13(85%) under 18. One case had bilateral infection, and 6/7(86%) having bilateral surgery developed the infection in their second operated eye. Clinical infection developed at mean 8.3 days (range 1-20) post-strabismus surgery, with 5/13(38%) demonstrating systemic signs e.g., fatigue, anorexia, fever, irritability. Associated previous diagnoses included: developmental delay (5/13,38%) and skin or ear infections (4/13,31%). Treatment included hospitalization (7/13,54%), with surgical incision/drainage in 4/13(31%). Surgical site cultures revealed MRSA (4/13,31%), MSSA (3/13,23%), and Group A Streptococcus (2/13,15%). Infection remained extraocular in all cases, but one eye lost vision (NLP) from optic atrophy. No common OR/surgeon/procedure/preparation-related risks were identified.
Discussion: Post-strabismus-surgery infections have recently become more common at Duke Eye Center, without obvious unifying cause, mostly in children, and were often associated with developmental delay, preceding non-ocular infection, and MRSA/MSSA.
Conclusion: Post-strabismus-surgery infection is vision-threatening, and our recent increased incidence despite meticulous pre-/intra-operative technique requires further investigation.
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3. Koederitz NM, Neely DE, Plager DA, et al. Postoperative povidone-iodine prophylaxis in strabismus surgery. J AAPOS. 2008;12(4):396-400.