Infectious necrotizing scleritis and proliferative vitreoretinopathy after scleral buckling in a patient with atopic dermatitis

Abstract

Purpose: To report a case of necrotizing scleritis and proliferative vitreoretinopathy due to an acute infection following scleral buckling for the management of rhegmatogenous retinal detachment in a patient with untreated atopic dermatitis.

Observations: A 40-year-old man with untreated atopic dermatitis presented with rhegmatogenous retinal detachment in his right eye. He underwent uncomplicated scleral buckling surgery with an encircling silicon sponge band, then noticed severe hyperemia and purulent discharge in the eye at 3 weeks after surgery. The silicon sponge was exposed and had migrated anteriorly. The patient was then diagnosed with post-scleral-buckling infection and underwent scleral buckle removal. Marked scleral thinning due to necrotizing scleritis was evident beneath the scleral buckle. Eye discharge culture findings were positive for Staphylococcus aureus. After removal of the scleral buckle, the patient's necrotizing scleritis improved, but he developed proliferative vitreoretinopathy. The patient then underwent pars plana vitrectomy, which resulted in reattachment of his retina.

Conclusions and importance: Although postoperative infection within 1 month after scleral buckling is rare, surgeons should note that patients with atopic dermatitis are at high risk of postoperative infection after scleral buckling, leading to the development of sight-threatening complications such as necrotizing scleritis, which could lead to incomplete retinal attachment and proliferative vitreoretinopathy.

Keywords: Atopic dermatitis; Necrotizing scleritis; Pars plana vitrectomy; Postoperative infection; Retinal detachment; Scleral buckling.

Fig. 1

Pictures of atopic dermatitis in this case: (A) face, (B) hands. The patient had not received treatment for his atopic dermatitis for several years. He had bilateral blepharitis and eczema. He rubbed both eyes frequently because of constant itching.

Fig. 2

Fundus photograph (A) and optical coherence tomography image (B) of the right eye. Macula-off rhegmatogenous retinal detachment with atrophic retinal holes was present in the nasal and temporal periphery (not shown). Vertical arrow shows the direction of the optical coherence tomography image.

Fig. 3

Optical coherence tomography image of the right eye at 1 week after scleral buckling. Subretinal fluid was reduced by scleral buckling.

Fig. 4

Slit lamp photographs of the right eye at 2 weeks after scleral buckling, in (A) up gaze and (B) right gaze. The silicon sponge was exposed and the conjunctiva was melted. The exposed silicon sponge had migrated anteriorly. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 5

Slit lamp photographs of the right eye after silicon sponge removal, in (A) right gaze and (B) left gaze. Marked scleral thinning and scleral melting were evident beneath the scleral buckle site. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 6

Composite 9-gaze slit lamp photographs of the right eye after silicon sponge removal. The conjunctival defect was epithelized with reduction in conjunctival injection. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 7

Intraoperative view of pars plana vitrectomy. Subretinal strand was removed, with 25-gauge forceps, through intentional retinal hole. Yellow arrows shows subretinal strand. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 8

Fundus photograph of the right eye after pars plana vitrectomy. There were well-healed laser scars around the retinal hole and iatrogenic retinal hole. The subretinal strand was completely removed.