Scleral Buckle Infection: What Are The Odds?

Scleral buckle infection
A. Scleral congestion B. Necrotic discharge (due to buckle infection) C. Clear eye D. Slight scleral thickening (after buckle removal). Source: BMC Ophthalomolgy

This article describes the case of a patient who developed scleral buckle infection 14 years after a buckling procedure for retinal detachment.

The 45 year old male presented to the hospital with complaints of discharge and redness in his right eye. He reported having undergone scleral buckling in the same eye 14 years ago. However, he did not report any history of trauma nor did he have any symptoms of a systemic disease. On examination, the patient’s right eye was blind to the extent of no light perception. Doctors could clearly see mucopurulent discharge and a displaced scleral buckle. They also noticed black deposits over the displaced scleral buckle suggesting it as the possible cause of infection.

The patient’s anterior chamber examination indicated normal aqueous humor and lens. On fundoscopy however, doctors noticed displacement of the buckel along with retinal detachment in the inferior segment. The doctors also examined the left eye of the patient. They found it completely normal with a visual acuity of 6/6.

Initial Diagnosis: Sequelae of Scleral Buckle Infection

After going through a round of history and examinations, doctors made the initial diagnosis of scleral buckle infection. Therefore, they planned to remove the buckle. They made an incision in the conjunctiva to remove the buckle which they then sent for microbiological examination. They removed all the necrotic and infected debris followed by washing the conjunctiva with antibiotic and antifungal agents. In the end, they stitched back the conjunctiva and started the patient on antibiotics and antifungals to mitigate any remaining infection.

The results from microbiology revealed the presence of pigmented hyphae and conidia based upon which, doctors made a diagnosis of Curvularia species. They kept the patient on an oral antibiotic for one week and an antifungal for 3 weeks. After a follow-up examination one month later where the patient did not show any further signs of infection, doctors stopped the medicines.

Scleral Buckle Infection: How Common is it?

Scleral buckling is a widely used primary surgical technique to treat rhegmatogenous retinal detachment (retinal detachment that occurs due to the development of retinal breaks). It involves the opening up of the eye through a conjunctival incision followed by the identification and treatment of retinal and vitreoretinal defects. A scleral buckle is then sutured to the sclera to provide support and the necessary force to keep the retina in place.

Scleral buckles come in a variety of forms. Doctors either use the body’s own grafts such as fascia lata, knee cartilage and tendons etc or employ sutures (both absorbable and non-absorbable), gelatin or silicon as scleral buckles. All of them give good results as success rates are 85-90%. Still, scleral buckling can result in complications including both intraoperative and postoperative complications.

Intraoperative Complications

The intraoperative complications can begin with damage to the corneal epithelium that can impair proper visualization of the retina and identification of retinal defects. Similarly, raised intraocular pressure during the procedure can cause corneal oedema which can result in deterioration of vision. Moreover, another common complication encountered at the operation table comes with constriction of the pupil known as pupillary miosis. Usually, it occurs as a result of hypotony of the radial muscles of the iris. Nevertheless, it can also develop due to irritation of the iris by the intravitreal gas used during the procedure.

Scleral perforation is also a common complication. It mostly occurs due to suturing needles and manifests in the form of blood and subretinal fluid at the suture site. Whenever a complication such as scleral perforation sets in, one should always release all kinds of pressures/tractions on the eye and examine the retina with an indirect ophthalmoscope.

Postoperative Complications: Scleral Buckle Infection

Postoperatively, the patients usually encounter complications associated with raised intraocular pressure such as corneal oedema. Moreover, the scleral buckle used in the procedure is prone to a lot of infections. Most commonly, the infections share a bacterial aetiology and respond well to antibiotics. However, this case describes a scleral buckle infection of fungal aetiology which is very rare. So much so that this is perhaps the only documented case of buckle infection caused by Curvularia species.


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