Buckle Infection Research Articles

Microbiologic spectrum and susceptibility of isolates in scleral buckle infection in India

To present the microbial spectrum and susceptibility of isolates in scleral buckle infections in India. Retrospective case series. Seventy-three isolates from 55 eyes with scleral buckle infection were studied. The isolates included 30 gram-positive cocci (41.1%), 15 acid-fast bacilli (20.5%), 11 fungi (15.1%), 10 gram-positive bacilli (13.7%), and 7 gram-negative bacilli (9.6%). Eighteen eyes (32.7%) had polymicrobial infections. Gram-positive, gram-negative, and acid-fast isolates were most commonly susceptible to vancomycin (93%), ciprofloxacin (86%), and amikacin (80%), respectively. This large single-center study indicates the high prevalence of fungal, acid-fast organisms and polymicrobial organisms in buckle infections.

A case of infected scleral buckle with Mycobacterium chelonae associated with chronic intraocular inflammation

Purpose: To describe a unique case of chronic intraocular inflammation secondary to scleral buckle infection with Mycobacterium chelonae that was successfully treated with buckle explantation. Methods: Case report. Results: A 59-year-old male with a history of retinal detachment repair at the age of 41 presented with chronic, recurrent intraocular inflammation responsive to topical corticosteroids. Conjunctival erosion with exposure of the scleral buckle occurred five months after initial presentation. The scleral buckle was removed and cultured. After three weeks of postoperative topical tobramycin and dexamethasone treatment, the patient has remained symptom-free without medications. The explanted material grew acid-fast bacilli later identified as M. chelonae. Conclusions: This case describes a new finding of chronic intraocular inflammation associated with a scleral buckle infected with M. chelonae and the successful resolution of extraocular infection and intraocular inflammation after buckle removal.

Fluorescein Angiographic Findings in an Infected Scleral Buckle

This report presents fluorescein angiographic (FA) findings in a patient with scleral buckle infection. Ten days following scleral buckling surgery, FA demonstrated dilated choroidal vessels over the buckle with leakage of fluorescein into the subretinal space. Irregular diffuse scleral thickening was noted on the computed tomography (CT). The findings of focal choroiditis with dilated leaky choroidal vessels seen on FA, or diffuse scleral thickening demonstrated by a CT may aid in establishing the diagnosis of scleral buckle infection.

BIOFILM ON SCLERAL EXPLANTS WITH AND WITHOUT CLINICAL INFECTION

Purpose: Biofilm is a glycocalyx matrix secreted by microorganisms that confers protection against host defenses and antimicrobial treatment. Biofilms have been implicated in the persistence of sclera) buckle infections. This study aimed to evaluate the incidence of biofilm growth on scleral explants and the relationship to explant infection. Methods: Scleral explants were obtained following removal for infection or extrusion or during repeat surgery. Explants were fixed with rhuthenium red and examined by scanning electron microscopy to visualize the glycocalyx. Results: A total of 28 explants were analyzed. Ten were removed because of either infection or extrusion and 18 were removed during repeat surgery. The mean time to removal of explants was 36 months in the infection/extrusion group and 12 months in the others. Biofilm was identified on five explants—two removed because of infection/extrusion and three for surgical indications. Bacterial elements were identified in all biofilms. Conclusions: Biofilm was identified on explants removed because of infection or exposure and on explants removed for technical reasons at repeat surgery. This implies that bacterial contamination and biofilm formation occur without exposure of the explant, probably due to inoculation at the time of initial surgery. Biofilms may contribute to the persistence of sclera) explant infections but a causative role in buckle extrusion is unproved.

Four cases of late infection following scleral buckling procedure

We report four cases with late infection following a scleral buckling procedure. These cases were a 44-year-old male, a 52-year-old female, a 59-year-old male, and a 60-year-old male. All of these cases developed conjunctival injection, chemosis, and mucopurulent discharge 7 to 15 years after the procedure. The symptoms did not improve despite months of medical therapy, suggesting scleral buckle infection, and finally the buckling materials were removed. Solid silicone was used in 2 cases, and a sponge was used in 2 cases, with encircling elements in 1 case, and without encircling elements in 3 cases. Pus culture of the removal exoplant revealed fungaul infection in 2 cases. The others were negative, but bacterial infection was suspected from their clinical course and intraoperative findings. After removal of the buckles, the symptoms improved rapidly in all cases and there was no recurrence of retinal detachment. Scleral buckle infection should be suspected and removal of buckling materials should be considered, in cases with refractory conjunctival and scleral inflammation even years after scleral buckling procedure.

Exogenous Endophthalmitis Initially Treated without Systemic Antibiotics

In 1987, the authors reported the successful eradication of infection in 16 patients with culture-proven acute exogenous bacterial endophthalmitis using intravitreal but no systemic antibiotics. They retrospectively reviewed additional consecutive cases since then to determine if the initial omission of systemic antibiotics remained reasonable. Twenty patients had culture-proven endophthalmitis. Four patients initially received systemic antibiotics for orbital cellulitis (2 patients), prevention of a possible scleral buckle infection (1 patient), and ascending cholangitis (1 patient). The remaining 16 patients were treated initially with intravitreal antibiotics only. Three of these additional 16 patients ultimately required systemic antibiotics for orbital cellulitis (1 patient), infectious scleritis (1 patient), and prevention of central nervous system infection with Neisseria meningitidis (1 patient). Only in one patient who had a neglected endophthalmitis and in whom an orbital cellulitis ultimately developed were we unable to clear the intraocular infection. In the overall series of 32 patients, cultures yielded staphylococcal species in 16 eyes, gram-positive bacilli in 3, streptococcal infection in 5, gram-negative cocci in 1, and gram-negative bacilli in 7. Half of the 14 specimens (1 aqueous and 13 vitreal) collected at the time of 16 reinjections in 13 eyes yielded organisms. Half (16/32) of the eyes attained visual acuity of 20/40 or better; 87.5% (28/32) attained visual acuity of 20/400 or better. Therapy with intravitreal antibiotics without systemic antibiotics is reasonable, unless the infection has extended (or is at risk to extend) beyond the globe. Such evidence includes an elevated temperature or leukocyte count, corneal ring abscess, proptosis, loss of extraocular movements, scleral abscesses or infectious scleritis, and, perhaps, the presence of a scleral buckle.

Scleral Buckle Removal Following Retinal Reattachment Surgery: Clinical and Microbiologic Aspects

Scleral buckle infection following retinal reattachment surgery is infrequent but not rare. We identified 45 cases among approximately 3000 scleral buckling procedures performed at our institution between July 1, 1985 and July 1, 1991. The scleral buckle was exposed in all 45, and the subsequent microbiologic culture was positive in 33. The most common causative organism was coagulase negative staphylococci (17 of 33 cases with positive cultures). Risk factors for an adverse outcome included positive culture, preoperative vision < or = 20/200, and preoperative retinal detachment. Broad spectrum antibiotics covered organism sensitivity profiles in 16 of the 18 cases tested. Prompt removal of infected buckles and treatment with broad-spectrum topical antibiotics are important for maintaining vision.

Biofilm and Scleral Buckle-associated Infections: A Mechanism for Persistence

AbstractScleral buckle infections tend to be persistent as well as resistant to antimicrobial treatment. Often, scleral buckle infections require removal of the buckling elements for resolution. To determine if bacteria are able to persist on scleral buckles by elaborating a glycocalyx matrix or biofilm that offers protection against host defenses and antimicrobial treatment, the authors cultured 28 scleral buckle elements removed for infection and extrusion. Bacteria were isolated from 18 elements (64%). The most frequently isolated bacteria were Staphylococcus epidermidis and other coagulase-negative staphylococci(8), Staphylococcus aureus(3), corynebacteria (3), Mycobacterium chelonei (3), and Proteus mirabilis (3). Eleven (65%) of 17 buckles evaluated with scanning electron microscopy demonstrated the presence of bacteria encased in biofilm. Biofilm was demonstrated on the surfaces and ends of solid silicon elements. In the silicon sponges, biofilm also extended into the matrix of the sponges. The authors believe that bacterial production of biofilm offers an explanation for the persistence of scleral buckle infections and their ability to withstand antimicrobial treatment.

SCLERAL BUCKLE INFECTIONS DUE TO ATYPICAL MYCOBACTERIA

Six cases of scleral buckle infections due to atypical mycobacteria were studied to determine their clinical and microbiologic features and the response of these infections to treatment. All infections were treated with exoplant removal and administration of a variety of antibiotics. Symptoms and clinical signs of infection resolved rapidly after treatment in all cases, and visual acuity returned to the best preoperative level in 5 of 6 cases. There are no clinical features to distinguish mycobacterial infections from other causes of scleral buckle infection, although scleral rupture occurred in 2 of 6 cases. The microbiologic evaluation of these cases showed 5 infections due to Mycobacterium chelonae and 1 infection due to Mycobacterium fortuitum. Species and subspecies differences correlated with different antibiotic susceptibilities. Amikacin most frequently offered the best antibiotic coverage, as cases with M. chelonae were resistant or only marginally sensitive to ciprofloxacin. As in scleral buckle infections caused by other bacteria, prompt exoplant removal and adjustment of antibiotic therapy based on culture sensitivities was the best treatment.

An experimental model to assess factors associated with scleral buckle infection.

A reproducible rabbit model to assess factors associated with scleral buckle infection was developed. Buckle exoplant material incubated with staphylococcus was sutured to rabbit sclera, covered with conjunctiva, then removed after 24 hours. Colony counts from removed exoplant material were used to define experimentally the degree of infection. Experimental modifications of the model were used to determine how differences in perioperative treatment may affect infection. Soaking sponge exoplant in antibiotic or subconjunctival injection of antibiotic had a marked beneficial effect, while prophylactic topical antibiotic drops, or systemically administered antibiotics had a less marked effect. Silicone sponge exoplant material showed a greater tendency towards bacterial contamination than did solid silicone.