Nishikiori and Ohguro he received uneventful scleral buckling surgery with an encircling silicone sponge band (#506G) with a sleeve (#70) and cryopexy for both eyes under general anesthesia. The total operation time was 110 minutes. Forty-eight hours after the surgery, he noticed chemosis of the bulbar conjunctiva and severe hyperemia in his right eye (Figure 1A). Slit-lamp examination revealed a clear looking anterior chamber, cornea, and lens. Fundus examination showed a clear view and the attached retina supported by the buckling proce- dure. P. aeruginosa, sensitive to penicillin, cephems, and carbapenem, was cultured from discharge from his right eye (Table 1). No problem was observed in his left eye. Beginning 48 hours after the surgery, he received a course of systemic antibiotics consisting of 2 g/day imipenem cilastatin intra- venously for 4 days, 2 g/day cefozopran HCl intravenously for 7 days, and 2 g/day cefcapene pivoxil hydrochloride intravenously for 7 days. Simultaneously, cefmenoxime hydrochloride, levoﬂoxacin, and sulbenicillin sodium drops were administered into the right eye six times a day for 14 days. Despite the treatments, the conjunctival chemosis and hyperemia only slightly improved, and additional puru- lent discharge appeared. Therefore we washed the silicone sponge explant by irrigating the buckle with exposure to 1 g cefazolin sodium and restoration of the conjunctiva at 20 days after the initial surgery. Then he received antibiotics consisting of 1 g/day meropenem trihydrate intravenously for an additional 7 days. Twenty-seven days after the initial surgery, his symptoms ﬁnally disappeared. However, three months after the initial surgery, he expe- rienced conjunctival chemosis, recurrent hyperemia, and the exposure of the silicone sponge explants (Figure 1B). Therefore we removed the scleral explant. Pseudomonas aeruginosa, which was sensitive to the same antibiotics as before was cultured from the removed scleral explant (Table 1). He received antibiotics consisting of 2 g/day cefozopran HCl intravenously for 4 days and 400 mg/day oral levoﬂozacin postoperatively. His symptoms immediately dis- appeared within 2 days after removal of the explant. Sixteen months after the removal the explant, the retina remained attached and the best-corrected visual acuity ﬁndings were 20/20 (OD) and 20/20 for (OS). Upon inquiry, he did not have any history of trauma or gross contamination of the ocular surface, systemic infection, or diabetes. Discussion The reported scleral explant infection incidence varies between 0.5% and 18%, and is affected by the surgical tech- nique, different synthetic materials of scleral explants, dura- tion of surgery, size, and position of the buckle (Russo and Ruiz 1971; Schwartz et al 1981; Roldan-Pallares et al 1999). Patients who are operated on with scleral buckling for rhema- togenous retinal detachment sometimes require removal of the implant because of infection, most commonly seen with the use of a silicone sponge (9%) or hydrogel implant (1.3%) and least commonly encountered with a silicon rubber band (0.6%) (Roldan-Pallares et al 1999). Of the identiﬁed bacteria in scleral buckling infection, coagulase-negative staphylo- coccus is the most common, and in acute-onset scleral explant infection, which is comparatively usual, S. aureus, Proteus mirabilis, and P. aeruginosa are commonly identiﬁed (Russo a b Figure 1A Although the conjunctival chemosis and hyperemia improved slightly, purulent discharge appeared from the temporal position of the buckle. B Three months after the initial surgery, conjunctival chemosis and hyperemia recurred, along with exposure of the silicone sponge explants. 224 Clinical Ophthalmology 2008:2(1)