Infectious conjunctivitis caused byPseudomonasaeruginosain infected and extrused scleral buckles

Abstract

Extrusion of the scleral buckle is one of the complications patients may encounter undergoing the surgical treatment for retinal detachment. We present two cases of persistent Pseudomonasaeruginosa-related conjunctivitis which infected the silicone explant after retinal surgery. One of them is a 73-year-old Caucasian female patient with hyperaemia, intense pain and mucopurulent discharge. After the conjunctival swabs detected a P. aeruginosa infection, she started both topical and systemic treatment without any results; for this reason we opted for the buckle removal always under systemic therapy. The second case is an 84-year-old Caucasian female patient with fever, periorbital oedema, chronic ocular pain, hyperaemia and purulent discharge. P. aeruginosa has also been detected in this case. No improvement with topical and systemic treatment, so this convinced us to remove patient's buckles and to continue systemic therapy. Both cases had the complete resolution after surgery. It is important to quickly recognise exposed scleral buckles because they can be a source of infections and a rare but threatening cause of endophthalmitis.

Atypical Microbiological Feature of Infectious Endophthalmitis on Jeju Island: A 10-Year Study at a Single Tertiary Referral Center

“…In exogenous endophthalmitis, the causative organism directly invades the eye. While postcataract endophthalmitis and posttraumatic endophthalmitis constitute the majority of exogenous endophthalmitis seen worldwide, endophthalmitis can also occur in conjunction with intravitreal injections, keratitis, bleb after filtering surgery, and scleral buckle [1,2].…”

“…In exogenous endophthalmitis, the causative organism directly invades the eye. While postcataract endophthalmitis and posttraumatic endophthalmitis constitute the majority of exogenous endophthalmitis seen worldwide, endophthalmitis can also occur in conjunction with intravitreal injections, keratitis, bleb after filtering surgery, and scleral buckle [ 1 , 2 ]. Postoperative cases accounted for 40–80%, and posttraumatic cases showed an incidence of 2–15% out of the total endophthalmitis cases in countries like England, Australia, Korea, and Brazil, whereas the incidence of posttraumatic endophthalmitis was higher in developing countries including India, Egypt, and Thailand [ 1 , 3 – 5 ].…”

“…There are few cases of endophthalmitis associated with scleral buckle [ 23 , 24 ]. Meduri et al [ 2 ] proposed that exposure to the scleral buckle could be a cause of endophthalmitis. The common pathogens of endogenous endophthalmitis in Western countries include Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli [ 6 ].…”