Table 1 The sensitivity of antibiotics Name of antibiotic Piperacillin (PIPC) Ceftazidime (CAZ) Cefoperazone: (CPZ) Cefsulodin (CFS) Aztreonam (AZT) Gentamicin (GM) Tobramycin (TOB) Amikacin (AMK) Minocycline (MINO) Sensitivity S δ 8 S δ 2 S δ 8 S δ 4 S = 4 S = 4 S δ 1 S δ 4 I = 8 Abbreviations: S, Sensitive; I, Indistinct; R, Resistant. An intractable scleral explant infection Name of antibiotic Sulfamethoxazole-trimethoprim (ST) Ciproﬂoxacin (CPFX) Fosfomycin (FOM) Imipenem (IPM) Levoﬂoxacin (LVFX) Sulbactam/cefoperazone (CPZ/SBT) Cefozopran (CZOP) Cefepime (CFPM) Meropenem (MEPM) Sensitivity N 2 R δ 0.25 S 16 S δ 1 S δ 0.5 S δ 16 S δ 2 S δ 4 S δ 1 and Ruiz 1971; Schwartz et al 1981; Lindsey et al 1983; placement, which resulted in a sevenfold decrease in infection Holland et al 1991; Smiddy et al 1993). The interval from (Arribas et al 1984). the scleral explant procedure to the infection ranges from 1 If we suspect the scleral explant infection, early diagnosis to 240 months (median, 8 months and within 6 months 47%) and countermeasures, ﬁrst considering conservative manage- (Schwartz et al 1981; Roldan-Pallares et al 1999). ment, and the appropriate timing for surgical treatment such In this study, we found that although clinically there was as exchanging the scleral explant if possible and removing an initial response to conservative management of the buckle- the scleral explant if it is appropriate, are required. We hope related infection, it recurred, and necessitated removal of the that our experience will help to improve the treatment of buckle. This occurred even though the organism was sensitive intractable cases of acute scleral explant infection. to the antibiotics used to treat the infection, and there was an appropriate duration of treatment. There have been no reports that conservative management successfully treated scleral explant infection. In addition, multiple-drug-resistant P. aeruginosa has become a clinical problem (Holland et al 1991; Chaudhry 1998; Asaria et al 1999). In our case, the P. aeruginosa was sensitive to multiple antibiotics and appropriate antibiotic treatment appeared to resolve the acute scleral explant infection (Table 1), but we were ﬁnally forced to remove the explant because the infection recurred. However conservative management may have a role to play in such infections by delaying buckle removal and thus pos- sibly reducing the risk of retinal redetachment after buckle removal (Schwartz and Pruett 1977). While some reports have suggested that removing the scleral explant causes retinal detachment (Russo and Ruiz 1971; Ulrich et al 1974; Schwartz and Pruett 1977; Schwartz et al 1981), in our case this did not occur, perhaps because we could maintain the screral explant for three months by treatment with antibiotics. To prevent scleral explant infection, one report investigated the value of soaking the scleral explant in antibiotics before References Arribas NP, Olk RJ, Schertzer M, et al. 1984. Preoperative antibiotic soak- ing of silicone sponges. Does it make a difference? Ophthalmology, 91:1684–9. Asaria RH, Downie JA, McLauglin-Borlace L, et al. 1999. Bioﬁlm on scleral explants with and without clinical infection. Retina, 19:447–50. Chaudhry NA, Tabandeh H, Rosenfeld PJ, et al. 1998. Scleral buckle infection with ciproﬂoxacin-resistant Pseudomonas aeruginosa. Arch Ophthalmol, 116:1251. Holland SP, Pulido JS, Miller D, et al. 1991. Bioﬁlm and scleral buckle- associated infections. A mechanism for persistence. Ophthalmology, 98:933–8. Lindsey PS, Pierce LH, Welch RB. 1983. Removal of scleral buckling ele- ments. Causes and complications. Arch Ophthalmol, 101:570–3. Roldan-Pallares M, del Castillo Sanz JL, Awad-El Susi S, et al. 1999. Long-term complications of silicone and hydrogel explants in retinal reattachment surgery. Arch Ophthalmol, 117:197–201. Russo CE, Ruiz RS. 1971. Silicone sponge rejection. Early and late compli- cations in retinal detachment surgery. Arch Ophthalmol, 85:647–50. Schwartz PL, Maris PJ, Maris CE. 1981. Silastic sponge implants in retinal detachment surgery. Ann Ophthalmol, 13:1089–92. Schwartz PL, Pruett RC. 1977. Factors inﬂuencing retinal redetachment after removal of buckling elements. Arch Ophthalmol, 95:804–7 Smiddy WE, Miller D, Flynn HW Jr. 1993. Scleral buckle removal follow- ing retinal reattachment surgery: clinical and microbiologic aspects. Ophthalmic Surg, 24:440–45. Ulrich RA, Burton TC. 1974. Infections following scleral buckling proce- dures. Arch Ophthalmol, 92:213–15. Clinical Ophthalmology 2008:2(1) 225