We report the case of a 76-year-old diabetic woman who underwent strabismus surgery with an adjustable retroinsertion of the lower rectum of OI with topical anesthesia, for presenting diplopia of cataract the following day.
Her initial VA was 0.7.
It was emmetropous, and the axial length of the eyeball was within normal limits.
In the immediate postoperative period, exudative conjunctivitis refractory to topical treatment with ciprofloxacin and tobramycin was observed.
At 15 days the patient came to the emergency department with severe ocular pain, normal MOE, lower eyelid edema, dilatation of episcleral vessels, IOP of 15 mmHg.
At the bottom of the eye he had a lower CD than at 24 hours and was annular, sometimes saw a sawnut without indentation.
The patient was admitted for study and treatment.
At 48 hours she reported loss of vision, VA was light perception, total exudative RD.
Blood tests were normal.
Conjunctival exudate culture and ocular ultrasound showed scleral thickening at the level of the lower rectum, with no signs of abscess.
The CT confirmed the diagnosis of serous choroidal detachment without hemorrhagic signs and scleritis.
Treatment with oral levofloxacin and prednisone was established.
The exudate culture was sterile and the same topical treatment was continued for norfloxacin, methylprednisolone and cyclolate.
Due to the poor evolution of the clinical picture, on the 5th day we proceeded to surgical exploration of the inferior rectus and the removal of the muscular sutures to sclera of vycril 6/0.
The muscle showed good coloration, but there was great adherence to the underlying sclera, which had a somewhat rough texture, cream colour.
Vancomycin and dexamethasone were injected.
The culture of intraoperative conjunctival samples was positive for Staphylococcus epidermis sensitive to aureomycin and vancomycin, so topical aureomycin was administered.
Oral levofloxacin treatment was continued for 15 days and oral prednisone decreased gradually when the retina was reapplied, continuous cyclole was resolved until topical methylprednisolone was maintained.
Retinal detachment was resolved within 75 days (with multifocal pigmentation to avoid macular detachment), CD within 105 days, remaining 0.7 with a final VA.
No scar or chorioretinal mark was observed at the level of the attachment defective puncture of the lower rectum that indicated inadvertent strabismus surgery.
