Buckle Infection Research Articles

Scleral buckle infection due to Nocardia cyriacigeorgica

A 34-year-old male complained of pain, discharge, and foreign body sensation in the right eye (RE) for 1 week. On anterior segment examination, RE had conjunctival congestion with an exposed buckle at 12 o’clock and buckle sutures covered with thin conjunctiva in the other quadrants. A diagnosis of an exposed and infected scleral buckle in RE was made, and buckle explant removal was done. Culture isolated Nocardia cyriacigeorgica from the explant. This case highlights the importance of surgeons being aware of Nocardia’s potential to cause buckle infection, its delayed manifestation, the need for timely diagnosis using microbiology, appropriate treatment using sensitive antibiotics, and proper follow-up.

MYCOBACTERIUM ABSCESSUS SCLERAL BUCKLE INFECTION.

To report the successful management of a rare case of Mycobacterium abscessus scleral buckle infection. Case report. A 63-year-old woman with a history of sarcoid anterior uveitis and macula-off retinal detachment repaired by scleral buckle and pars plana vitrectomy presented with eye pain, redness, and purulent drainage in the left eye. Slit-lamp examination showed superonasal scleral buckle exposure, purulent conjunctival discharge, corneal edema, nongranulomatous keratic precipitates, and anterior chamber cell and flare. The patient underwent urgent scleral buckle removal. Intraoperatively, an area of scleral thinning without perforation underneath the exposed buckle was discovered and covered with a scleral patch graft, and an amniotic membrane graft was used to cover an area of bare sclera with significant conjunctival scarring and retraction. Cultures grew M. abscessus panresistant except to amikacin. After 6 weeks of fortified amikacin drops and a long taper of topical steroid therapy for persistent postoperative anterior uveitis, the patient's symptoms resolved. Mycobacterium is an emerging causative agent of scleral buckle infections. Our report provides insights about the management of such cases.

Scleral buckle infection with Aspergillus and pyogenic granuloma: A case report

Scleral buckle infection with Aspergillus and pyogenic granuloma: A case report

Comparison of Povidone-Iodine and Gentamicin Soak as Scleral Buckle Infection Prophylaxis.

ObjectiveTo determine the best method of antimicrobial prophylaxis against implanted material-associated infections in the setting of scleral buckle surgery.DesignExperimental study.ParticipantsScleral buckle elements were soaked in either gram-positive or polymicrobial broth, while control buckle elements were soaked in PBS only.MethodsSolid silicone and sponge scleral buckle elements were inoculated with common pathogens of the ocular surface, and then soaked in either 1% or 5% povidone-iodine, 1 mg/mL gentamicin solution, or sterile saline for 1, 5, 10, or 15 minutes. Bacteria were then isolated from the buckle elements and cultured for 24 hours.ResultsIn all gram-positive bacterial conditions, gentamicin solution decreased the bacterial load from 451,666.67 colony-forming units (CFU)/mL to 171,611.11 CFU/mL (p=0.0004). The fractional bacterial survival after soaking in gentamicin was higher for the silicone sponge than band (0.357 vs 0.079, p=0.038). Both 1% and 5% povidone-iodine were able to completely eradicate all gram-positive bacteria of both buckle elements. Only 5% povidone-iodine was able to completely sterilize all microbes on the buckle after soaking in a polymicrobial solution consisting of gram-positive, gram-negative bacteria, and fungi.ConclusionPovidone-iodine solution was significantly more effective at bacterial eradication compared to gentamicin solution. For all scleral buckle procedures, we recommend soaking the buckle element in 2–3% povidone-iodine solution before placement and rinsing the ocular surface with the same solution after placement.

Inclusion conjunctival cyst after infected buckle removal

This case report describes the unique presentation of post buckle infection, inclusion conjunctival cyst. A 17-year-old male presented with pain, redness and a mass lesion in the left eye status post an infected scleral buckle removal. Surgical exploration revealed retained sutures and the capsule presumed to be formed around the buckle. After removal of both, patient was asymptomatic with stable BCVA and fundus findings. Surgical management includes not just the removal of the buckle material, but also the buckle sutures and the capsule formed around the episcleral buckle implant to completely remove the foci of infection and inflammation.

Outcome of Non-drainage Scleral Buckling in Primary Rhegmatogenous Retinal Detachment

Introduction: Scleral buckling (SB) was the principal surgical intervention for patients with rhegmatogenous retinal detachment (RRD) until the development of pars plana vitrectomy. The study aims to evaluate the outcome of SB without subretinal fluid (SRF) drainage in RRD.
 Materials and methods: A retrospective observational study was conducted at a tertiary eye care center. Charts of patients operated with SB without SRF drainage for RRD between January 2014 and December 2015 were evaluated. The main outcome measure was the primary reattachment rate at 1 month after single SB surgery. Other outcome measures were final reattachment rate after further intervention, visual improvement and relation of various parameters with retinal reattachment.
 Results: One hundred and seventeen patients were included of which 90 (76.9%) were men. Mean age was 26.68±12.6 years (Range 9-60). All eyes were phakic. Only 1 patient had a macula on RD. The primary reattachment rate was 84.6% (n=99). Mean LogMAR (±SD) visual acuity (VA) improved from 1.92(±0.46) to 1.02(±0.42). Extent of RD, number of breaks, and type of break was found to have no association with retinal reattachment. Association between type of PVR and status of retina post buckling was found to be significant (p=0.026) with retinal reattachment seen in 100% in PVR-A and only 60% in PVR-C2. Final reattachment rate was 98.2%. Complications encountered were postoperative diplopia (n=1), suture granuloma (n=1) and buckle infection (n=2).
 Conclusion: Scleral buckling without SRF drainage, an exclusively extra ocular procedure, is an effective and safe treatment modality for non-complicated RRD.

Early Buckle Migration and Restrictive Strabismus after Successful Medical Management of Scleral Buckle Infection

ABSTRACTWe report a case of restrictive strabismus caused by early scleral buckle (SB) migration within 1 month of surgery after successful medical management of SB infection. A 24 year-old man underwent scleral buckling surgery for left eye inferior retinal detachment (RD). A solid silicone buckle element was placed inferiorly along with an encircling silicone band. Two days after surgery, he presented with SB infection. Methicillin resistant Staphylococcus aureus was cultured from the exudate at conjunctival suture sites. Since the retina was well attached and it was only the second postoperative day, it was decided to retain the buckle. SB infection was treated with intravenous cefotaxime and topical fortified cefazolin and successfully eradicated. One month thereafter, anterior SB migration was noted on slit lamp biomicroscopy. Restrictive strabismus and diplopia were also noted. Eventually, SB removal was performed at 2 months. This case report highlights the role of infection and subsequent inflammation as a cause for buckle migration and restrictive strabismus in the early post-operative period. These changes can be seen as early as 1 month after primary surgery and may occur even after successful medical management of the SB infection.

Microbiological profile and antibiotic susceptibility of scleral buckle infections in North India.

Purpose:The aim of this article to study causative organisms for scleral buckle (SB) infections in North India.Methods:A retrospective review of records was done for all patients who have undergone SB removal at our institute between January 2009 and December 2017. The records were analyzed for etiological agent of the infected buckle and its antibiotic sensitivity.Results:A total of 43 samples were analyzed and a positive culture was noted in 35 (81.40%) cases. The buckle infection rate at our institute was noted to be 2.53%. The commonest organism causing SB infections was Staphylococcus – 15 (42.6%) cases, followed by Pseudomonas – 6 (17.14%) cases and Fungi – 6 (17.14%) cases. The median interval between retinal detachment surgery and buckle explantation was 3 years.Conclusion:A large variety of organisms may cause SB infections. The commonest organism found to cause buckle infections in our study was Staphylococcus sp.

Sutureless Belt Loops versus Sutured Buckle Technique in Combination with Vitrectomy for Retinal Detachment Repair: A Comparative Analysis

Objective: To compare the anatomic and visual outcomes in primary rhegmatogenous retinal detachment repair involving combined pars plana vitrectomy (PPV)/scleral buckle (SB) using a sutureless belt loops technique versus a conventional sutured buckle technique. Methods: This is a retrospective, consecutive, interventional, comparative case series study using patients treated for primary retinal detachment who underwent the SB procedure in combination with PPV. Details regarding anatomic and visual outcome were analyzed. Results: Thirty-five eyes were included in this study: 18 eyes (18 patients) treated with combined PPV and SB performed using a sutureless belt loops technique (group A) and 17 eyes (17 patients) treated with combined PPV and SB sutured to the sclera (group B). Successful anatomic attachment and appropriate buckle height were achieved in all 35 cases. There was 1 case of redetachment in each group during the follow-up: 1/17 (5.9%) in group A and 1/18 (5.6%) in group B (p = 0.97). No cases of buckle infection, extrusion, or intrusion were noted during the follow-up period. Conclusion: SBs installed using a belt loops sutureless technique appear to be as safe and effective as those applied using conventional suturing for repair of retinal detachment, with similar anatomic and functional outcomes.

A rare case of scleral buckle infection with Curvularia species

BackgroundScleral buckling is an established modality of treating retinal detachment. Being an external implant the buckle may be prone to infections. We report such a case with a delayed presentation and a rare etiology.Case presentationA 45 year old male presented with redness, foreign body sensation and discharge for one month in his right eye. The patient had undergone a retinal detachment surgery elsewhere 14 years back without any visual gain. Right eye demonstrated no perception of light and the best corrected visual acuity in the left eye was 6/6, N6. On downgaze an exposed and anteriorly displaced scleral buckle was identified with black deposits and mucopurulent material overlying the buckle. Scleral buckle removal was done. On microbiological examination Curvularia species was identified. Successful treatment with antifungals was done.ConclusionsScleral buckle infection with dematiaceous fungi is a rare occurrence. To the best of our knowledge this is the first case report describing a buckle infection caused by the curvularia species.

Diagnostic Approach to Ocular Infections Using Various Techniques From Conventional Culture to Next-Generation Sequencing Analysis.

Ocular infection is caused by both endogenous (resident) and exogenous (environmental) microbes. As the ocular surface interacts with both outer environment and its own resident microbiota, clinical ocular samples are predicted to contain a diverse set of microorganisms. Microscopy of sample smears is an important step in the diagnostic process of infectious diseases to interpret the culture results. Traditional culture techniques have several limitations in the detection and/or identification of uncharacterized bacteria of environmental origin. Molecular biological techniques, such as polymerase chain reaction of pathogen-specific virulence genes, 16S rRNA gene clone library analysis, and next-generation sequencing of 16S rDNA amplicons, compensate for diagnostic culture techniques in diagnosing infectious diseases. These techniques are expected to provide novel insights into the ocular microbiota and pathology of ocular infections. In this article, we describe various ocular infections, including contact lens-related keratitis, silicone buckle infection, and dacryocystitis, which were analyzed using molecular biological techniques. The advantages and disadvantages of these highly sensitive and inclusive microbiological detection systems for ocular infections are discussed.

Methicillin-resistant Staphylococcus aureus buckle infection complicated by endophthalmitis and presumed choroidal abscess in a patient with ulcerative colitis

This patient presented with excessive pain, lid swelling, erythema, heat and limitations of extraocular movement (OD) nine days after a scleral buckle (SB) and pneumopexy surgery. Complicated buckle infection with endophthalmitis was impressed. Bacterial culture yielded methicillin-resistant Staphylococcus aureus. A choroidal abscess was identified 1 week after the episode. Complete visual recovery from hand motion to 20/30 (OD) was achieved with buckle removal, subconjunctival and intravitreal antibiotics. Endophthalmitis and choroidal abscess formation after SB surgery is extremely rare. Host factors including ulcerative colitis may play a role in causing the severe buckle infection of this patient.

Nontuberculous mycobacterial ocular infections--comparing the clinical and microbiological characteristics between Mycobacterium abscessus and Mycobacterium massiliense.

PurposeTo analyze the clinical characteristics of nontuberculous mycobacterial (NTM) ocular infections and the species-specific in vitro antimicrobial susceptibility.Material and MethodsIn 2000 to 2011 at the National Taiwan University Hospital, multilocus sequencing of rpoB, hsp65 and secA was used to identify NTM isolates from ocular infections. The clinical presentation and treatment outcomes were retrospectively compared between species. Broth microdilution method was used to determine the minimum inhibitory concentrations of amikacin (AMK), clarithromycin (CLA), ciprofloxacin (CPF), levofloxacin (LVF), moxifloxacin (MXF) and gatifloxacin (GAF) against all strains. The activities of antimicrobial combinations were assessed by the checkerboard titration method.ResultsA total of 24 NTM strains (13 Mycobacterium abscessus and 11 Mycobacterium massiliense) were isolated from 13 keratitis, 10 buckle infections, and 1 canaliculitis cases. Clinically, manifestations and outcomes caused by these two species were similar and surgical intervention was necessary for medically unresponsive NTM infection. Microbiologically, 100% of M. abscessus and 90.9% of M. massiliense ocular isolates were susceptible to amikacin but all were resistant to fluoroquinolones. Inducible clarithromycin resistance existed in 69.3% of M. abscessus but not in M. massiliense isolates. None of the AMK-CLA, AMK-MXF, AMK-GAF, CLA-MXF and CLA-GAF combinations showed synergistic or antagonistic effect against both species in vitro.Conclusions M. abscessus and M. massiliense are the most commonly identified species for NTM ocular infections in Taiwan. Both species were resistant to fluoroquinolones, susceptible to amikacin, and differ in clarithromycin resistance. Combined antimicrobial treatments showed no interaction in vitro but could be considered in combination with surgical interventions for eradication of this devastating ocular infection.

A Case ofPseudomonas aeruginosaInfection after Scleral Buckling for Retinal Detachment

Purpose: To report a case of Pseudomonas aeruginosa infection after scleral buckling for retinal detachment. Case summary: A 68-year-old male presented with a 2-day history of pain in the right eye. The patient had a history of scleral buckling for retinal detachment 10 years earlier and excisional biopsy for conjunctival mass 1 month previously. Biopsy revealed chronic inflammation and granulation tissue formation. Slit-lamp examinations revealed superior conjunctival injection, edema and exposed suture knot. Fundus examination revealed exudative retinal detachment and choroidal detachment. The conjunctival lesion did not improve although the patient was treated with moxifloxacin. After 4 days, bacterial and fungal cultures were performed because the conjunctiva presented with purulent discharge 4 days after treatment. The scleral buckle and suture knot were removed. The cultures revealed growth of Pseudomonas aeruginosa. According to antibiotic sensitivity test results, the authors treated the patient with ceftazidime. The conjunctival lesion, choroidal detachment and exudative retinal detachment were improved. Conclusions: In patients with conjunctival injection, edema, purulent discharge and ocular pain after scleral buckling, presence of infection should be suspected. If scleral buckle infection is suspected, bacterial culture, antibiotics treatment and scleral buckle removal should be considered. J Korean Ophthalmol Soc 2015;56(10):1646-1649

CHANGING PROFILE OF ORGANISMS CAUSING SCLERAL BUCKLE INFECTIONS

To study the microbiological spectrum and in vitro susceptibility of bacterial isolates from explanted scleral buckles and to correlate clinical presentation to the causative agent. Medical records of patients who underwent buckle explantation from July 2007 to May 2012 were reviewed retrospectively. Clinical features and microbiological profile were noted and correlated. Twenty of 24 buckles (83.33%) from 24 patients grew 21 isolates. Isolates included 6 acid-fast bacilli (28.57%; atypical mycobacteria = 5, Nocardia asteroides = 1), 5 gram-positive bacilli (23.8%; Corynebacterium spp. = 4, Bacillus sp. = 1), 4 gram-positive cocci (19.0%; Staphylococcus spp. = 4), 2 gram-negative bacilli (9.5%; Pseudomonas aeruginosa = 2), and 4 fungi (19.0%; Aspergillus spp. = 3, Paecilomyces sp. = 1). Acid-fast bacilli and gram-negative bacilli were sensitive to amikacin and gram-positive bacilli and gram-positive cocci to vancomycin. Buckle exposure within 2 years of primary surgery tended to be noninfective (P = 0.06). Fungal or mycobacterial infections were more symptomatic than those with Corynebacterium species. Results of microscopic examination of conjunctival swab in 5 of 7 eyes (71.4%) were consistent with culture of conjunctival swab and explanted buckles. Clinical features and microscopic examination of conjunctival swab may give a lead toward the causative organism in suspected buckle infections. Based on these leads, vancomycin and amikacin may be used as the initial empirical therapy.

Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility

BackgroundThe purpose of the present study was to evaluate the microbiological spectrum and antimicrobial susceptibility in patients with scleral buckle infection. Medical records of all the patients diagnosed as buckle infection at L. V. Prasad Eye Institute between July 1992 and June 2012 were reviewed in this non-comparative, consecutive, retrospective case series.FindingsA total of 132 eyes of 132 patients underwent buckle explantation for buckle infection during the study period. The incidence of buckle infection at our institute during the study period was 0.2% (31 out of 15,022). A total of 124 isolates were identified from 102 positive cultures. The most common etiological agent isolated was Staphylococcus epidermidis (27/124, 21.77%) followed by Mycobacterium sp. (20/124, 16.13%) and Corynebacterium sp. (13/124, 10.48%). The most common gram negative bacilli identified was Pseudomonas aeruginosa (9/124, 7.26%). The median interval between scleral buckling surgery and onset of symptoms of local infection was 30 days. All eyes underwent buckle explantation and median time interval between primary SB surgery and explantation was 13 months. Recurrent retinal detachment was observed in two cases at 7 and 48 months, respectively, after buckle explantation. Gram positive, gram negative, and acid-fast organisms isolated from 2003 to 2012 were most commonly susceptible to vancomycin (100%), ciprofloxacin (100%), and amikacin (89%). Susceptibility to ciprofloxacin during the same time period was observed in 75% (15/20), 100% (13/13), and 87% (7/8) of gram positive, gram negative, and acid-fast isolates, respectively.ConclusionScleral buckle infection is relatively rare and has a delayed clinical presentation. It is most commonly caused by gram positive cocci. Based on the current antimicrobial susceptibility, ciprofloxacin can be used as empirical therapy in the management of scleral buckle infections.

Prophylaxis for acute scleral buckle infection using 0.25 % povidone-iodine ocular surface irrigation during surgery

To investigate whether repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling surgery minimizes ocular surface bacterial contamination at completion of the procedure. A total of 489 consecutive eyes that underwent scleral buckling at a single institution were categorized into two groups according to the intraoperative ocular surface washing method used during two separate time periods--a group using physiological saline (saline group, 222 consecutive eyes) and a group using 0.25 % povidone-iodine (PI group 267, consecutive eyes). In 37 eyes of each group, ocular surface fluids were sampled at the beginning of surgery and at completion of buckling, and subjected to bacteriological culture. Acute scleral buckle infection occurred in one patient, and was caused by Pseudomonas aeruginosa. The incidence of acute scleral buckle infection was 0.45 % (1/222 eyes) in the saline group, and 0 % in the PI group, with no significant difference (P = 0.4540). The bacterial detection rates in ocular surface fluid at the beginning of surgery were 5.4 % (2/37 eyes) using saline and 8.1 % (3/37 eyes) using povidone-iodine, with no significant difference (P = 0.6433). The rates at completion of buckling were 18.9 % (7/37 eyes) using saline and 0 % (0 eye) using povidone-iodine, with a significant difference (P = 0.0114). Repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling procedure reduced the ocular surface bacterial contamination rate to an extremely low level at completion of buckling, suggesting that this method is useful for the prevention of acute scleral buckle infection.

Ocular infections caused by non‐tuberculous mycobacteria: update on epidemiology and management

To provide an update on the frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria. Retrospective study of university clinic patients. One hundred thirty-nine patients with culture confirmed non-tuberculous mycobacteria infections seen at Bascom Palmer Eye Institute from January 1980 to July 2007. Chart review of data collected included patients' demographics, risk factors, microbiological profiles and clinical outcomes. Frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria. A total of 183 non-tuberculous mycobacteria isolates from 142 eyes were identified, with a fourfold increase in the number of eyes infected with non-tuberculous mycobacteria from 1980-1989 (13.4%) to 2000-2007 (56.3%). Eighty-three percent of non-tuberculous mycobacteria isolates were identified as M. abscessus/chelonae. The majority (91%) of isolates were recovered within 10 days. Common diagnoses included keratitis (36.6%), scleral buckle infections (14.8%) and socket/implant infections (14.8%). Identifiable risk factors were presence of biomaterials (63.1%), ocular surgery (24.1%) and steroid exposure (77%). The median time from diagnosis of culture positive non-tuberculous mycobacteria infection to resolution was 13 to 24 weeks. Combination therapy was used to treat 80% of infected eyes. In vitro susceptibility of non-tuberculous mycobacteria isolates were: amikacin, 81%; clarithromycin, 93%; and moxifloxacin, 21%. The incidence of ocular infections caused by non-tuberculous mycobacteria has increased within the last 8 years, with a high number of biomaterial associated infections among this group. Clinical diagnosis and microbiological confirmation of non-tuberculous mycobacteria infections remains challenging. Patient outcomes may be improved by early diagnosis, appropriate therapy and removal of biomaterials.

Scleral buckle infection with aspergillus flavus

Purpose:To present a case of scleral buckle infection with Aspergillus flavus in a tertiary eye center in Saudi Arabia.Methods:A retrospective case report of a 28-year-old Saudi male who presented with a six-month history of conjunctival injection and discharge from the left eye which had undergone uncomplicated conventional retinal detachment surgery, at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, in the form of cryopexy, subretinal fluid drainage and scleral buckle (grooved segmental sponge and circumferential band with sleeve) for a macula on retinal detachment four years earlier. A diagnosis of infected extruded scleral buckle was made and the buckle was removed.Results:The infected scleral buckle was removed under local anesthesia with administration of sub-conjunctival irrigation of 50 mg solution of Vancomycin, and sub-conjunctival injection of 25mg of Vancomycin. Post operative microbiological studies revealed infection with silver staining of moderate Aspergillus flavus hyphae. Visual acuity of the left eye improved from 20/200 before surgery to 20/60 in the two years follow-up visit.Conclusion:This case report indicates the importance of considering infection with multiple organisms – including fungal ones – in cases of scleral buckle infections in our population.

Radiologic Findings in Infected and Noninfected Scleral Buckles

To present the radiologic findings in scleral buckle infections and in the early postoperative period after scleral buckling. Retrospective multicenter orbital computed tomography (CT) study of 14 patients and brain magnetic resonance (MR) in one patient with scleral buckle infections, some with the referring diagnosis of endophthalmitis, proliferative vitreoretinopathy, orbital cellulitis, or unilateral headache. The control population consisted of early postoperative prospective CT study of 38 consecutive patients with scleral buckle without clinical infection. Diffuse scleral thickening and preseptal soft tissue swelling were noted in acute scleral buckle infections. Scleral thickening decreased radiologically following prompt antibiotic therapy in five patients with acute infections. Silicone sponge had low attenuation without infection and high attenuation with infection. In chronically infected scleral buckle, the sclera was thickened around the buckle, with scleral melt under the buckle. MR showed increased signal intensity in the preseptal region in one patient with chronic fungal infection. In the controls, two had thickening of the sclera without soft tissue swelling. CT or MR can assist in the early diagnosis and management of scleral buckle infections.