Explanted Scleral Buckle, a retrospective study

Abstract

 

Purpose

 

Scleral buckle (SB) is a surgery for rhegmatogenous retinal detachment (RD) indicated mainly in phakic patients for inferior retinal tears. SB are foreign bodies and increase risk of infection, which affects prognosis of surgery. This study evaluated the incidence, clinical signs, treatment and microbiology in patients who underwent explantation of SB due to its infection.

 

Methods

 

Microbiological profile spectrum and antimicrobial susceptibility of microorganisms were evaluated in explanted SB sent to microbiology analysis at Hospital das Clinicas - University of Sao Paulo (USP), between 2011 and 2012, from patients presenting clinical signs of infection.

 

Results

 

SB for RD were implanted in 229 eyes, from 229 patients, and 9 (3.93%) presented signs of infection. The onset of symptoms was registered for five patients (55.55%) between postoperative month 3 to 60, time until explant varied from 4 to 60 months. Two eyes underwent scleral introflexion (SI) (22.22%), 3 underwent posterior vitrectomy (PV) (33.33%), 2 was submitted to a combined surgery (SI and PV) and 2 patients underwent a procedure of SI, PV and phacoemulsification (22.22%). Pain was the most common symptom (44.44%), in addition to conjunctival hyperemia (33.33%), ocular discharge (33.33%), hyposphagma (16.66%), photophobia (16.66%), sudden visual loss (16.66%) and foreign body sensation (16.66%). Culture was positive in 8 (88.88%), the etiological agents isolated were Staphylococcus aureus (37.5%), Staphylococcus epidermidis (25%), Pseudomonas aeruginosa (12.5%), Corynebacterium spp. (12.5%), Pantoea spp. (12.5%). The evaluation of the susceptibility to 25 antibiotics revealed sensitivity of all microorganisms to ciprofloxacin. It was seen resistance to cefepime (100%), penicillin (66,7%), gentamicin (33,3%), moxifloxacin (16,67%). The topic antibiotic used was a quinolone and the oral antibiotic was a cephalosporin. The preoperative best corrected visual activity (BCVA) ranged from light perception to hand movement. The postoperative BCVA ranged from no light perception to 20/25.

 

Conclusions

 

Although the results represent experience of a single center, there was no significant change in microbiological profile and sensitivity patterns compared to other studies. Gram positive bacterias are still the main microorganisms associated to SB infections and ciprofloxacin remains an excellent choice antibiotic for initial treatment.