Buckle infection and exudative retinal detachment following a deep scleral bite: management and outcome

During a standard 279 scleral buckle (SB) procedure, an inadvertent deep scleral suture bite occurred. On postoperative day (POD) 5, the patient presented with pain, reduced vision (counting fingers close to the face), conjunctival congestion, restricted ocular motility and exudative retinal detachment, with symptomatic improvement following buckle removal. Recurrent retinal detachment subsequently occurred, associated with proliferative vitreoretinopathy changes as a stiff inferior retinal fold after resolution of the exudation. The patient underwent repeat surgery, during which thick subretinal exudative material was identified. Silicone oil tamponade was used. At 3 months, silicone oil was removed, and the retina remained attached, with a final visual acuity of 20/20. Appropriate suture depth during SB placement is critical to avoid scleral penetration and buckle-related complications. When infection is suspected, prompt buckle removal and timely surgical intervention for recurrent retinal detachment may help achieve favourable anatomical and visual outcomes.