Orbital Cellulitis Associated with Scleral Buckle Infection Caused by Macrolide-Resistant Mycobacterium abscessus Complex: A Case Report and Literature Review.

Ocular infections following scleral buckle placement for retinal detachment, though rare, can lead to significant complications such as orbital cellulitis and endophthalmitis. While Mycobacterium chelonae and M. fortuitum complexes were historically the most common nontuberculous mycobacteria (NTM) associated with these infections, cases caused by Mycobacterium abscessus complex (MABC) are rising, posing therapeutic challenges. We report a case of M. abscessus subsp. abscessus (MAB) scleral buckle infection with orbital cellulitis in a 69-year-old male, successfully managed with buckle removal and prolonged systemic antimicrobial therapy. The isolate demonstrated multidrug resistance, including phenotypic macrolide resistance, despite no genotypic mutations detected in erm(41) or rrl. Treatment with imipenem, amikacin, tigecycline, clofazimine, and azithromycin resolved the infection. A review identified 12 cases of MABC scleral buckle infections, underscoring the need for comprehensive surgical and pharmacologic approaches. This case highlights the importance of molecular diagnostics, phenotypic testing, and species-level identification in managing these challenging infections.