Abscessed Hydroxyapatite Orbital Implants A Report of Two Cases

PURPOSE: The authors describe the rare condition of an abscess within a hydroxyapatite orbital implant in two patients who had undergone seemingly uncomplicated enucleation and orbital implant surgery. METHODS: In the first patient, 14 weeks postoperatively, a chronic discharge developed and the socket became uncomfortable. A pyogenic granuloma was present, occurring over an area of dehiscence. The hydroxyapatite orbital implant was removed 10 months postoperatively. In the second patient, moderate orbital discomfort was noted during the first week postoperatively along with a temporal shift of the implant. The discomfort persisted, and 1 week later a discharge began. The implant was removed 9 weeks after implantation. At the time of surgery, an unsuspected pyogenic granuloma was found in the medial conjunctival formix overlying a small area of implant dehiscence. RESULTS: Conjunctival and implant cultures grew Staphylococcus aureus in our first patient, whereas coagulase-negative staphylococci were cultured from the conjunctiva and implant in our second patient. Results of histopathologic examination of both implants disclosed an abscess cavity containing clusters of gram-positive cocci. CONCLUSION: Persistent orbital discomfort, discharge, and the development of a pyogenic granuloma after hydroxyapatite implant should warn the ophthalmic surgeon of potential implant infection.