Scleral buckle infections due to atypical mycobacteria

Six cases of scleral buckle infections due to atypical mycobacteria were studied to determine their clinical and microbiologic features and the response of these infections to treatment. All infections were treated with exoplant removal and administration of a variety of antibiotics. Symptoms and clinical signs of infection resolved rapidly after treatment in all cases, and visual acuity returned to the best preoperative level in 5 of 6 cases. There are no clinical features to distinguish mycobacterial infections from other causes of scleral buckle infection, although scleral rupture occurred in 2 of 6 cases. The microbiologic evaluation of these cases showed 5 infections due to Mycobacterium chelonae and 1 infection due to Mycobacterium fortuitum. Species and subspecies differences correlated with different antibiotic susceptibilities. Amikacin most frequently offered the best antibiotic coverage, as cases with M. chelonae were resistant or only marginally sensitive to ciprofloxacin. As in scleral buckle infections caused by other bacteria, prompt exoplant removal and adjustment of antibiotic therapy based on culture sensitivities was the best treatment.