title: Elevated white blood cell count may predict risk of orbital implant exposure.
abstract: OBJECTIVE
  To determine the risk factors for primary implant exposure after enucleation and evisceration in infected eyes.
  
  
  METHODS
  Retrospective, comparative case series.
  
  
  METHODS
  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.
authors: Department of Ophthalmology, Kaohsiung Veterans General Hospital; Yuh-Ing Junior College of Health Care and Management, Kaohsiung. Electronic address: ysbee@vghks.gov.tw.
authors: Youn-Shen
authors: YS
authors: Bee
authors: Department of Ophthalmology, Kaohsiung Veterans General Hospital.
authors: Muh-Chiou
authors: MC
authors: Lin
authors: Department of Ophthalmology, Kaohsiung Veterans General Hospital; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Shwu-Jiuan
authors: SJ
authors: Sheu
authors: Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA.
authors: John D
authors: JD
authors: Ng
mesh_terms: D000368:Aged; D009877:Endophthalmitis / Q000382:microbiology / Q000601:surgery; D015353:Eye Enucleation; D017234:Eye Evisceration; D015818:Eye Infections, Bacterial / Q000382:microbiology / Q000601:surgery; D015821:Eye Infections, Fungal / Q000382:microbiology / Q000601:surgery; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D020273:Orbital Implants; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000175:diagnosis* / Q000209:etiology