Our Summary

This research paper is about a successful surgical procedure that was performed on a patient who had a severe eye infection, caused by Pseudomonas aeruginosa bacteria, due to an infected eye implant known as a scleral buckle. The infection had spread throughout the eye, a condition known as panophthalmitis.

In the procedure, the surgeons removed the infected buckle and the stitches holding it in place. They also inserted a special washing system under the eyelid to help clean out the infection. After two months, the patient’s vision had improved to being able to detect hand movements.

This is the first reported case of successfully saving the eye (globe salvage) in such a severe situation. The paper suggests that in similar cases, surgeons should remove all parts of the infected buckle and stitches, and always test the removed material for infection - even if it doesn’t look infected. It also recommends the use of the special washing system for severe Pseudomonas aeruginosa eye infections.

FAQs

  1. What is the recommended surgical technique for managing an infected scleral buckle?
  2. What is the importance of performing a routine culture of all explanted material during scleral buckle surgery?
  3. What is the role of a subpalpebral lavage in cases of severe Pseudomonas aeruginosa ocular infections?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scleral buckle surgery is to make sure to follow all post-operative care instructions closely, including taking any prescribed medications and attending follow-up appointments. It is important to report any unusual symptoms or changes in vision to your doctor immediately. Additionally, maintaining good hygiene and proper eye care can help prevent infection and promote successful healing after surgery.

Suitable For

Patients who are typically recommended scleral buckle surgery include those with retinal detachment, particularly those with a high risk of recurrence or those with complicated forms of retinal detachment such as proliferative vitreoretinopathy. Other indications for scleral buckle surgery include giant retinal tears, tractional retinal detachments, and certain cases of macula-off retinal detachment. Additionally, patients with a history of scleral buckle surgery who develop complications such as buckle infection may also require surgical intervention.

Timeline

Before scleral buckle surgery:

  • Patient experiences symptoms such as blurred vision, flashes of light, floaters, or loss of vision.
  • Patient undergoes a comprehensive eye examination, including imaging tests such as ultrasound or optical coherence tomography, to determine the extent of retinal detachment.
  • Surgeon recommends scleral buckle surgery as a treatment option for retinal detachment.

After scleral buckle surgery:

  • Patient is monitored closely for any signs of infection or complications.
  • Patient may experience discomfort, redness, and swelling in the eye following surgery.
  • Visual acuity gradually improves as the retina reattaches to the back of the eye.
  • Follow-up appointments are scheduled to monitor the healing process and ensure the success of the surgery.
  • In cases of infection, the scleral buckle and sutures may need to be explanted, and additional treatments such as subpalpebral lavage may be necessary for management of the infection.

What to Ask Your Doctor

  1. What is the purpose of scleral buckle surgery?
  2. What are the risks and potential complications associated with scleral buckle surgery?
  3. How long is the recovery process after scleral buckle surgery?
  4. Will I need to take any special precautions or medications after the surgery?
  5. How likely is it for the scleral buckle to become infected, and what are the signs of infection?
  6. What is the success rate of scleral buckle surgery in treating retinal detachment?
  7. Are there any alternative treatment options to scleral buckle surgery for retinal detachment?
  8. How often will I need to follow up with my doctor after the surgery?
  9. What can I expect in terms of visual acuity and eye function after the surgery?
  10. Is there anything specific I should watch out for or be concerned about during the recovery period?

Reference

Authors: Gupta N, Weisenthal R, Swan RT, Spalding SC, Breazzano MP. Journal: Eur J Ophthalmol. 2024 Mar;34(2):589-593. doi: 10.1177/11206721231213402. Epub 2023 Nov 13. PMID: 37956464