Infection following strabismus surgery

Bilateral sterile sub-tenon abscess with vicryl suture reaction following strabismus surgery: A case report

INTRODUCTION AND IMPORTANCE

After strabismus surgery, infections and complications are uncommon but avoidable with the right aseptic measures. Rarely have cases of non-infectious sub-tenon abscesses been documented in the past; these cases need to be appropriately recognized and treated.

CASE PRESENTATION

In this report we describe a case of bilateral sub-tenon abscess 4 weeks after medial rectus recession. Despite receiving topical antibiotics for 7 days, there was no improvement, and multiple conjunctival cultures and sensitivity showed no growth. Both eye's sub-tenon abscess was drained, irrigated with gentamicin, and the fragile suture was removed.

CLINICAL DISCUSSION

Sub-tenon abscess has been associated with bacterial infection which has more sever presentation. Several facts, including the lack of organisms in the pre-operative and intraoperative cultures, the presence of big cells resembling foreign bodies, and the improvement that occurred after suture extrusion, make infection unlikely in this case.

CONCLUSION

We concluded that suture reaction is most likely to be responsible for a late-onset sub-tenon abscess with a negative culture and no response to antibiotics, and the suture should be removed.

The Infection Control Route in the Operating Room Effectively Reduces the Wound Infection of Patients

Surgical care is one of the significant aspects of global healthcare, with approximately 234 million operations being conducted annually. Surgical treatment has a substantial risk of complications and death. This study was conducted to explore the application effect of the infection control route in the operating room on the wound infection prevention care of patients. The clinical data of 136 patients receiving surgical treatment from October 2018 to October 2019 were retrospectively analyzed. The participants were assigned via random draw at a ratio of 1 : 1 to receive either routine care management (control group) or the infection control route (research group). The surgical wound infections of patients in the two groups were compared. The research group had higher scores in surgical materials management and disinfectant management than the control group (P < 0.01). In the research group, the total number of colonies within 5 minutes before surgery, 25 minutes after the start of surgery, and after surgery were all smaller than those in the control group (P < 0.01). There were no significant differences in the grade B healing rate between the two groups (P > 0.05), and the research group had a significantly higher healing rate in grade A than the control group, but its grade C healing rate and wound infection rate were significantly lower than those in the control group (P < 0.05). In the research group, the length of hospital stay, the time to get out of bed, the antibiotic use duration, and the stitch removal time was significantly shorter than those in the control group (P < 0.0001). The research group received a higher clinical nursing satisfaction than the control group (P < 0.05). The infection control route in the operating room for infection prevention care effectively reduces the wound infection rate of patients and accelerates their postoperative recovery.

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

Anaesthetic considerations for strabismus surgery in children and adults

Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%-80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in children outweigh the risks of anaesthesia. General anaesthesia is suitable for patients of all age groups, for complicated or repeated surgery, and bilateral eye procedures. Regional ophthalmic block reduces the incidence of oculocardiac reflex and emergence agitation, and provides postoperative analgesia, but requires a cooperative patient as many experience discomfort. Topical anaesthesia has been used in pharmacological injection, minimally invasive surgery, uncomplicated conventional strabismus surgery and some adjustable suture strabismus surgery. Its use, however, is only limited to cooperative adult patients. Prophylactic antiemesis with both ondansetron and dexamethasone is recommended, especially for children. A multimodal analgesia approach, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anaesthetic and minimal opioid usage, is recommended for postoperative analgesia, while a supplementary regional ophthalmic block is at the discretion of the team.

Extraocular and Intraocular Infections Following Strabismus Surgery: A Review

An extensive literature review of various types of infections following strabismus surgery was facilitated by using the search engines PubMed and Google Scholar. In both search engines, the phrases "infection following strabismus surgery," "infection strabismus surgery," "complications of strabismus surgery," "endophthalmitis strabismus surgery," and "strabismus scleral perforation" were used for the review. The type of infection, surface involved, and site of the infection determined the type of therapy. Infections involving deeper tissues, such as periocular infection or orbital cellulitis, required systemic therapy. Sub-Tenon's abscesses required incision and drainage, as well as systemic antibiotics. The development of endophthalmitis following strabismus surgery was rare, but was usually devastating to the visual result. Symptoms of an adverse intraocular condition began by mean postoperative day 3, but the definitive diagnosis and treatment of endophthalmitis was not made until mean postoperative day 6. Despite early detection of this latter type of infection and early surgical intervention with vitreous paracentesis and intraocular injection of antibiotics, the visual result was extremely poor in more than two-thirds of the reported cases. Although there is no known way to truly prevent all infections following strabismus surgery, several techniques may be prudent for the strabismus surgeon to adopt to decrease the bacterial load and minimize the risk of infection. The surgeon should be encouraged to consider preoperative use of povidone-iodine on the operative field and avoid scleral perforation during surgery. [J Pediatr Ophthalmol Strabismus. 2019;56(4):214-221.].