C A S E R E P O R T An intractable case of Pseudomonas aeruginosa infection after scleral buckling for rhegmatogenous retinal detachment Nami Nishikiori Hiroshi Ohguro Department of Ophthalmology, Sapporo Medical University School of Medicine Correspondence: Nami Nishikiori Department of Ophthalmology, Sapporo Medical University School of Medicine, South-1,West-16, Chuo-ku, Sapporo, Japan 060-8543 Tel +81 11 611 2111 (Ext. 3435) Fax +81 11 613 6575 Email nami731978@sapmed.ac.jp Background: Scleral buckling is still a common procedure to repair rhematogenous retinal detachment, and acute or chronic infection of the scleral explant is rare. We report an intractable case of acute scleral explant infection by Pseudomonas aeruginosa. Case: A 36-year-old man suffered from acute scleral explant infection by P. aeruginosa forty- eight hours after scleral buckling for rhegmatogenous retinal detachment. The infection was treated by intravenous administration of various appropriate antibiotics for eighteen days and washing the scleral explant with appropriate antibiotics, and appeared to be resolved. However, three months after the initial surgery, we had to remove the scleral explant because of recurrent infection. Observations: We encountered an intractable case of acute scleral explant infection by P. aeruginosa, that recurred and forced the removal of the scleral explant. Conclusions: We found that recurrence of infection necessitated removal of the scleral explant, even though the organism was sensitive to the antibiotics used to treat the infection, and there was an appropriate duration of treatment. Early diagnosis and countermeasures, ﬁrst consider- ing conservative management, which may have a role in delaying buckle removal, and thus reduce the risk of retinal redetachment, and help prolong the time until surgical treatment such as removing the scleral explant is required. Keywords: acute scleral explant infection, Pseudomonas aeruginosa, rhegmatogenous retinal detachment Scleral buckling is still a common procedure to repair rhematogenous retinal detach- ment, and acute or chronic infection of scleral explants is rare. However, once scleral explant infection occurs, almost all cases are intractable and require the removal of the explant (Schwartz et al 1981; Roldan-Pallares et al 1999). In addition, multiple drug- resistant bacteria such as methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa have become a clinical problem (Holland et al 1991; Chaudhry et al 1998; Asaria et al 1999). This is a report about a patient with intractable scleral explant infection by P. aeruginosa that was still sensitive to multiple antibiotics. First, appropriate antibiot- ics appeared to resolve the acute scleral explant infection, but three months after the initial surgery we had to remove the explant because of recurrent infection. Case report A 36-year-old man presented with rhematogenous retinal detachment in both eyes. On the initial examination, his best-corrected visual acuity ﬁndings were 20/20 (OD) and 20/50 (OS). Two days after the diagnosis of rhematogenous retinal detachment, Clinical Ophthalmology 2008:2(1) 223–225 © 2008 Nishikiori and Ohguro, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 223