{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:05:52Z","timestamp":1760058352316,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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 Staphylococcus aureus (MRSA) colonization, which persisted despite multiple eradication attempts. Methods: 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. Results: 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. Conclusions: 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.<\/jats:p>","DOI":"10.3390\/children12040457","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T05:43:33Z","timestamp":1743572613000},"page":"457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Giant Cyst of Dermis-Fat Graft in a Child with MRSA\u2014Case Report"],"prefix":"10.3390","volume":"12","author":[{"given":"Biljana","family":"Kuzmanovi\u0107 Elabjer","sequence":"first","affiliation":[{"name":"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 \u201cSveti Duh\u201d, Sveti Duh 64, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjana","family":"Bjelo\u0161","sequence":"additional","affiliation":[{"name":"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 \u201cSveti Duh\u201d, Sveti Duh 64, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3041-4186","authenticated-orcid":false,"given":"Ana","family":"\u0106uri\u0107","sequence":"additional","affiliation":[{"name":"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 \u201cSveti Duh\u201d, Sveti Duh 64, 10000 Zagreb, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daliborka","family":"Mileti\u0107","sequence":"additional","affiliation":[{"name":"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 \u201cSveti Duh\u201d, Sveti Duh 64, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mladen","family":"Bu\u0161i\u0107","sequence":"additional","affiliation":[{"name":"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 \u201cSveti Duh\u201d, Sveti Duh 64, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia"},{"name":"Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, Crkvena 21, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1080\/08820538.2017.1353830","article-title":"Postoperative Complications of Dermis-Fat Autografts in the Anophthalmic Socket","volume":"33","author":"Starks","year":"2018","journal-title":"Semin. Ophthalmol."},{"key":"ref_2","first-page":"49","article-title":"Giant Cyst as a Dermis Fat Graft Complication in Socket Anophthalmia Post Enucleation: Poster Presentation-Case Report-Resident","volume":"S2","author":"Fedora","year":"2023","journal-title":"Ophthalmologica. Indonesiana."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"498","DOI":"10.3928\/1542-8877-19870701-06","article-title":"Macrocystic enlargement of orbital dermis-fat grafts","volume":"18","author":"Patrinely","year":"1987","journal-title":"Ophthalmic Surg. Lasers Imaging Retin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1089\/wound.2023.0097","article-title":"\u0111; Piku\u0142a, M. Chemotherapy-Mediated Complications of Wound Healing: An Understudied Side Effect","volume":"13","author":"Sachadyn","year":"2024","journal-title":"Adv. Wound Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2551","DOI":"10.1007\/s00210-023-02781-2","article-title":"Effects of Chemotherapy on the Immune System: Implications for Cancer Treatment and Patient Outcomes","volume":"397","author":"Sharma","year":"2024","journal-title":"Naunyn. Schmiedebergs. Arch. Pharmacol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1038\/sj.ejcn.1601438","article-title":"Abdominal vs buttock adipose fat: Relationships with children\u2019s serum lipid levels","volume":"56","author":"Mamalakis","year":"2002","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1001\/archopht.1983.01040020588018","article-title":"Autogenous dermis-fat orbital implantation","volume":"101","author":"Guberina","year":"1983","journal-title":"Arch. 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