Four months after uneventful bilateral Ahmed glaucoma valve in 11 month old baby girl, the patient suddenly developed severe unilateral periorbital pain, erythema and swelling associated with moderate fever. Initially, only mild corneal haze was noted. The diagnosis of orbital cellulitis was confirmed by Computed Tomography and the patient received periorbital injection of gentamicin around the valve under light general anesthesia in addition to systemic empirical IV antibiotics. Over the next 48 hours, Anterior chamber hypopyon was noted which necessitated valve removal and intravitreal injection of fortified antibiotics. The valve, which was found full of pus, was extracted together with the scleral patch graft followed by irrigation of the valve area with povidone iodine and gentamycin solutions. Finally, injection of intravitreal fortified antibiotics was performed. Postoperatively, marked improvement was observed both clinically and radiologically. The increasing IOP was then managed by diode laser cycloablation that resulted in controlled IOP with preservation of useful vision. |
