Kuzmanović Elabjer Biljana, Bjeloš Mirjana, Ćurić Ana, Miletić Daliborka, Bušić Mladen
University Eye Department, Reference Center of the Ministry of Health of the Republic of Croatia for Pediatric Ophthalmology and Strabismus, Reference Center of the Ministry of Health of the Republic of Croatia for Inherited Retinal Dystrophies, Reference Center of the Ministry of Health of the Republic of Croatia for Standardized Echography in Ophthalmology, University Hospital "Sveti Duh", Sveti Duh 64, 10000 Zagreb, Croatia.
Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia.
Children (Basel). 2025 Apr 2;12(4):457. doi: 10.3390/children12040457.
BACKGROUND/OBJECTIVES: This case report presents a unique case of multiple postoperative complications, including sterile silicone implant extrusion, symblepharon formation, and the development of a giant cyst, following extensive multimodal chemotherapy for unilateral retinoblastoma in a pediatric patient. The case was further complicated by recurrent methicillin-resistant (MRSA) colonization, which persisted despite multiple eradication attempts.
A 5-year-old boy presented with right-sided proptosis one year after receiving a secondary dermis-fat orbital graft. He had undergone 12 cycles of intravitreal, intra-arterial, and systemic chemotherapy as well as thermotherapy and cryotherapy due to recurrent retinoblastoma in the right eye. Following a third relapse, secondary enucleation was performed with a primary silicone orbital implant. However, extrusion of the implant occurred, and an orbital swab confirmed MRSA colonization. A secondary dermis-fat graft was harvested and implanted after ensuring MRSA clearance. A year later, the child developed rapid right-sided proptosis. Ultrasound revealed a cyst within the dermis-fat graft measured 23.6 mm in anteroposterior diameter. Surgery was postponed due to chickenpox, and the cyst enlarged reaching an anteroposterior diameter of 26.7 mm over two months. A complete excision was performed.
The surgery was uneventful. Intraoperative orbital swab was sterile, but MRSA was detected in a conjunctival swab, leading to treatment with local moxifloxacin drops and oral rifampicin.
Giant cyst formation in a dermis-fat graft is an extremely rare complication. Complete excision remains the treatment of choice. However, in this case, it resulted in persistent anophthalmic socket syndrome, posing further reconstructive challenges.
背景/目的：本病例报告呈现了一例独特的术后多并发症情况，该患儿因单侧视网膜母细胞瘤接受广泛多模式化疗后，出现了包括无菌性硅胶植入物挤出、睑球粘连形成以及巨大囊肿形成等并发症。此外，耐甲氧西林金黄色葡萄球菌（MRSA）反复定植使病情更加复杂，尽管多次尝试根除，但仍持续存在。
一名5岁男孩在接受二次真皮脂肪眶部移植一年后出现右侧眼球突出。由于右眼视网膜母细胞瘤复发，他接受了12个周期的玻璃体内、动脉内和全身化疗以及热疗和冷冻治疗。第三次复发后，进行了二次眼球摘除术并植入了原发性硅胶眶内植入物。然而，植入物发生了挤出，眼眶拭子证实存在MRSA定植。在确保MRSA清除后，采集并植入了二次真皮脂肪移植物。一年后，患儿右侧眼球迅速突出。超声检查发现真皮脂肪移植物内有一个囊肿，前后径为23.6毫米。由于水痘，手术推迟，囊肿在两个月内增大至前后径26.7毫米。随后进行了完整切除。
手术顺利。术中眼眶拭子无菌，但结膜拭子检测到MRSA，因此采用局部莫西沙星滴眼液和口服利福平进行治疗。
真皮脂肪移植物中形成巨大囊肿是一种极为罕见的并发症。完整切除仍然是首选治疗方法。然而，在本病例中，这导致了持续性无眼球眶综合征，带来了进一步的重建挑战。
