BACKGROUND
Glaucoma drainage implants, including the Paul glaucoma implant, are widely used in the management of refractory glaucoma when medical therapy and conventional filtering surgery prove insufficient. Although associated with favorable outcomes, rare but serious postoperative complications such as endophthalmitis and panophthalmitis can occur, resulting in significant visual morbidity.
CASE REPORT
We describe the case of a 77-year-old man with chronic angle-closure glaucoma who developed acute panophthalmitis with orbital cellulitis 12 days following uneventful Paul glaucoma implant surgery. He presented with severe ocular pain, eyelid swelling, restricted ocular motility, and marked reduction in visual acuity to light perception. Clinical examination revealed pronounced anterior and posterior segment inflammation. B-scan ultrasonography showed dense vitreous opacities, shallow choroidal detachment, and ocular wall thickening. Computed tomography of the orbit confirmed associated orbital cellulitis with proptosis and extraocular muscle swelling. The patient underwent vitreous tap with intravitreal vancomycin, ceftazidime, and dexamethasone, along with intensive topical and systemic antimicrobial therapy. Despite an initial partial response, progressive inflammation required pars plana vitrectomy. Removal of the glaucoma drainage implant was not possible intraoperatively due to severe inflammation. Microbiological cultures remained negative throughout. With coordinated multidisciplinary management involving glaucoma, retina, and oculoplastic services, orbital inflammation gradually resolved, and visual acuity improved from light perception to 20/250 at final follow-up.
CONCLUSIONS
This case highlights the importance of close postoperative monitoring to ensure correct diagnosis and aggressive management of infections, preservation of globe integrity, and optimization of visual outcomes following glaucoma drainage device surgery.

Keywords: Ophthalmology; Glaucoma; Glaucoma Drainage Implants; Endophthalmitis; Orbital Cellulitis; Case Reports; Panophthalmitis