TITLE:
Perioperative care following strabismus surgery for the patient with severe congenital neutropenia
AUTHORS:
Joon Ho Park, Kyoung Min Kang, Bo Young Chun
KEYWORDS:
Congenital Neutropenia; Perioperative Care; Strabismus Surgery
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.2 No.1,
March
25,
2013
ABSTRACT: A 10-year-old girl
presented with esotropia. She had 35 prism diopters of esodeviation at far and
near with left inferior oblique muscle overaction (+3). Cycloplegic refraction
was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The
patient was being treated with G-CSF (Leufokine?) due to her severe
congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it.
Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the
periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops
in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery,
profuse irrigation with the entire bottle of topical antibiotics (Vigamox?,
moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed
topical and highly potent systemic antibiotics for 1 week. This is the first
case report to describe the successful perioperative antisepsis care following
strabismus surgery for a patient with severe congenital neutropenia. Prevention
of postoperative infection in granulocytopenic patients could be achieved
using antibiotic agents which provide the
greatest spectrum of coverage against both Gram-positive and
Gram-negative infections.