Elevated white blood cell count may predict risk of orbital implant exposure

Objective: To determine the risk factors for primary implant exposure after enucleation and evisceration in infected eyes. Design: Retrospective, comparative case series. Participants: Patients who underwent enucleation or evisceration for infected eyes. Methods: Records of patients who underwent enucleation or evisceration for infected eyes with placement of solid sphere implants were reviewed. Preoperative white blood cell (WBC) count, microbiologic laboratory results, clinical features, medical treatment, and surgical methods were recorded to evaluate the risk for implant exposure. Results: Eighty-five infected eyes were collected. The mean age was 70.1 years. The positive culture rate was 69.4%. In 42 patients with endophthalmitis or panophthalmitis, the most common microorganisms were Pseudomonas aeruginosa in 6 cases (20.7%) and Klebsiella pneumoniae in 7 cases (24.1%). In 50 patients with keratitis or scleritis, the most common microorganisms were P. aeruginosa in 14 eyes (46.7%) and Fusarium in 4 eyes (13.3%). There was a 12.9% exposure rate for the 85 patients. Preoperative WBC count was significantly higher in patients with implant exposure compared with those without exposure (p = 0.04). Preoperative WBC count more than 9500 cells/L had significantly higher exposure (p = 0.001). Conclusions: Preoperative elevated WBC count was associated with higher risk for implant exposure. Primary implantation after enucleation or evisceration may be less safe in infected eyes with high preoperative WBC count.