To evaluate the use of subtenon amikacin injection for the treatment of Nocardia asteroides orbital cellulitis in a patient with a history of scleral buckle surgery.Methods:
A 79-year-old diabetic woman presented with an 8-month history of diplopia, discharge, and swelling around her left eye. She had a scleral buckle surgery in this eye about 15 years ago. Examination of the left eye showed a visual acuity of 20/80, swollen and ptotic upper eyelid, chemotic conjunctiva, and limited extraocular motility. Magnetic resonance imaging showed an abscess under the scleral buckle. The scleral buckle was removed, and the abscess under the scleral buckle was drained. N. asteroides grew on the culture. Despite 4 months of the systemic trimethoprim/sulfamethoxazole and the topical fortified amikacin therapy, her infection worsened. After 5 monthly subtenon amikacin injections, the infection regressed dramatically, and her vision improved to 20/70. She used the systemic trimethoprim/sulfamethoxazole for 10 more months. After a 1-year follow-up, her external examination was normal, except for the left upper eyelid ptosis.Conclusion:
Subtenon amikacin injection can be added to the regimen for N. asteroides orbital cellulitis, of which surgical drainage, systemic and topical antibiotic therapies are not enough to control infection.