Late-onset Pseudomonas aeruginosa orbital cellulitis following glaucoma drainage device implantation

Abstract

Purpose: To present a rare case of late-onset Pseudomonas aeruginosa orbital cellulitis following glaucoma drainage device (GDD) implantation due to suture erosion. Observations: A 65-year-old male with a history of aphakic glaucoma and two remote prior glaucoma drainage device (GDD) surgeries of the right eye presented with right orbital signs. On examination, exposed securing Gore-Tex suture material over the plate of a GDD in the inferotemporal quadrant was present. Computed tomography (CT) scan demonstrated right orbital fat stranding, lateral rectus enlargement, and an intracapsular abscess consistent with orbital cellulitis. Cultures grew Pseudomonas aeruginosa. Treatment with intravenous and topical fortified antibiotics, incision and drainage of the abscess, and removal of the inferotemporal GDD was successful in resolving the infection. At post-operative month three, the patient underwent uncomplicated transscleral cyclophotocoagulation for further intraocular pressure control. Conclusions and Importance: Orbital cellulitis is an uncommon complication of GDD implantation, and typically occurs in the early post-operative period. To our knowledge, this is the first report of late-onset orbital cellulitis resulting from Pseudomonas aeruginosa, as well as the first case of GDD orbital cellulitis related to suture erosion.

Keywords

• Glaucoma drainage device
• Orbital cellulitis
• Pseudomonas aeruginosa
• Intracapsular abscess
• Suture erosion