Our Summary

This research paper discusses a successful treatment of a rare eye infection, caused by a bacterium called Mycobacterium abscessus, in a 63-year-old woman. The patient had a history of eye conditions, and her current symptoms included eye pain, redness, and a pus-like discharge. Upon examination, the doctors found an exposed device (scleral buckle) in her eye that was used in a previous surgery to fix a detached retina.

They performed an emergency procedure to remove this exposed device and found an area of thinning in the outer layer of her eye. This area was patched up, and a special type of graft (amniotic membrane graft) was used to cover another area of her eye with significant scarring.

The infection was found to be caused by Mycobacterium abscessus, which was resistant to most antibiotics except one called amikacin. The patient was treated with this antibiotic for six weeks, along with a long course of steroid therapy for another condition (uveitis). Following this treatment, her symptoms resolved.

The report concludes that Mycobacterium is an emerging cause of infections in the eye, specifically in cases where a scleral buckle device is used. The study provides useful insights on how to manage such infections.

FAQs

  1. What is Mycobacterium abscessus scleral buckle infection?
  2. How was the Mycobacterium abscessus scleral buckle infection managed in the reported case?
  3. What are the symptoms of Mycobacterium abscessus scleral buckle infection?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scleral buckle surgery is to closely monitor the eye for any signs of infection, such as redness, pain, or discharge. If any of these symptoms occur, it is important to seek immediate medical attention to prevent complications. Additionally, following post-operative care instructions, such as using prescribed medications and attending follow-up appointments, is crucial for a successful recovery.

Suitable For

Scleral buckle surgery is typically recommended for patients with retinal detachment, particularly those with a high risk of retinal redetachment or those with complex retinal detachments. Patients with conditions such as high myopia, lattice degeneration, or a history of trauma are often candidates for scleral buckle surgery. Additionally, patients with proliferative vitreoretinopathy or other factors that may increase the risk of retinal detachment may also be recommended for scleral buckle surgery.

Timeline

Before Scleral Buckle Surgery:

  • Patient experiences symptoms such as eye pain, redness, and purulent drainage in the affected eye.
  • Examination reveals scleral buckle exposure, purulent conjunctival discharge, corneal edema, keratic precipitates, and anterior chamber inflammation.
  • Patient undergoes urgent scleral buckle removal to address the infection and associated complications.

After Scleral Buckle Surgery:

  • Intraoperatively, scleral thinning without perforation is discovered underneath the exposed buckle and addressed with a scleral patch graft.
  • Amniotic membrane graft is used to cover an area of bare sclera with significant conjunctival scarring and retraction.
  • Cultures reveal infection with Mycobacterium abscessus, which is panresistant except to amikacin.
  • Patient is treated with 6 weeks of fortified amikacin drops and a long taper of topical steroid therapy for persistent postoperative anterior uveitis.
  • Patient’s symptoms eventually resolve after treatment.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scleral buckle surgery, including the risk of infection?
  2. How will the doctor monitor for signs of infection post-surgery?
  3. What symptoms should the patient watch for that may indicate an infection, and when should they contact the doctor if they experience these symptoms?
  4. How is an infection typically treated if it occurs after scleral buckle surgery?
  5. Are there any specific factors that may increase the risk of infection in this particular case, such as underlying medical conditions or previous surgeries?
  6. How long is the typical recovery period after scleral buckle surgery, and what follow-up appointments will be necessary to monitor for complications?
  7. Are there any lifestyle changes or precautions the patient should take to reduce the risk of infection after surgery?
  8. Will the patient need to take any medications or follow a special post-operative care routine to help prevent infection?

Reference

Authors: Cai S, Song A, Borkar DS. Journal: Retin Cases Brief Rep. 2023 Nov 1;17(6):744-746. doi: 10.1097/ICB.0000000000001277. PMID: 35344534