Nontuberculous mycobacterial infection after frontalis sling surgery using silicone rod

Abstract

PurposeThe purpose of this study is to report a case of nontuberculous mycobacterial infection after frontalis sling surgery.MethodA 65-year-old man presented with bilateral painful, erythematous lesions in the brow and upper eyelids. He had a history of frontalis sling surgery for myopathic ptosis 2 years back and all lesions were found localized to the tract of the silicone rod used in the previous frontalis sling surgery.ResultIncision and drainage of the lesions with microbiological analysis revealed significant growth of coagulase negative staphylococcus and Mycobacterium fortuitum. Sensitivity-based antibiotic treatment with intravenous amikacin was started, but poor response necessitated eventual explantation of both silicone rods for relief of symptoms. Culture of the explanted rods revealed similar results of M. fortuitum infection. Five months after the acute presentation, the patient is asymptomatic.ConclusionNontuberculous mycobacterial infection may be a delayed onset complication in frontalis sling surgery using silicone rods.

Infected ptosis surgery – a rare complication from a multidrug-resistant organism

“… 10 There were other reports of post-ptosis surgery complicated by long-standing postoperative infection which were mostly associated with mycobacterium or candida infection. 11 , 12 However, to our knowledge, there was no reported case of long-standing post-ptosis surgery infection involving multidrug-resistant Acinetobacter species. Acinetobacter rarely colonizes implant materials; 13 it commonly causes nosocomial infections such as pneumonia, urinary tract infection, and skin infections.…”

Efficacy of frontalis suspension with silicone rods in ptosis patients with poor Bell's phenomenon

“…[12] Bilateral Candida and atypical mycobacterial infection after frontalis sling suspension with silicone rod have been reported. [1314] Tuberculosis is an endemic disease in India, and it should be kept as a differential diagnosis when patients with silicone sling develop granuloma. The exposed slings and granuloma material were sent for microbiological assay but did not show any organism.…”

Results and Complications of Silicone Frontalis Sling Surgery for Ptosis

“…One case of non-tubercular infection was reported in a 65-year-old case of myopathy ptosis that occurred 2 years after the silicone frontalis suspension. 35 Various materials have been used for frontalis suspension. Autologus fascia lata [4][5][6][7] has been used for more than 100 years and remains the tissue of choice for frontalis suspension because of its longlasting effect and lower rate of complications; however, it was not used in our cases because the parents refused its harvesting when told about resultant scarring.…”

“…Several synthetic materials have become available in the armamentarium of the oculoplastic surgeons that include polypropylene 15,16 monofilament nylon suture, [16][17][18] Mersilene mesh (Ethicon, Somerville, NJ), [19][20][21][22][23][24][25] 26,27 and silicone, [28][29][30][31][32][33][34][35][36][37] which are being used more frequently compared to fascia lata. Use of these materials is not free from complications.…”