A 42-year-old Chinese man, known case of renal cell carcinoma with lung metastasis, was referred to Universiti
Kebangsaan Malaysia Medical Centre for left eye blurring of vision for one month duration, which was worse upon
waking up in the morning and cleared up after 1-2 hours. On examination, visual acuities were 6/6 in both eyes. No
relative afferent pupillary defect. Left fundus showed inferonasal retinal detachment without macular involvement.
No retina break, no retinitis and no choroidal lesion seen. Right eye examination was normal. Optical coherence
tomography (OCT) of left eye showed subretinal fluid temporal and inferior to optic disc. Fundus fluorescein
angiography (FFA) left eye showed hypofluoresence in early phase but hyperfluorescence with pin point leakage in
late phase over inferonasal quadrant. Indocyanine green (ICG) showed early hypofluoresence with late pin point
hyperfluoresence in the same quadrant. A clinical diagnosis of exudative retinal detachment due to choroidal
metastasis secondary to renal cell carcinoma was made. The patient was planned for cyber-knife radiotherapy of his
left eye but unfortunately we lost the follow up. High index of suspicion and relevant investigation are needed for
patients with visual complaints and history of renal cell carcinoma to diagnose choroidal metastasis.
Scleral buckle placement is a well-established technique for the treatment of primary rhegmatogenous retinal
detachment. Complications associated with scleral buckle are uncommon and its presentations can be vary. We
report a case of recurrent orbital cellulitis with anterior segment ischemia following a forgotten episode of previous
scleral buckling surgery, presenting with blurring of vision, redness and swelling of the lids. The presence of scleral
buckle was detected by detailed examination and confirmed by orbital imaging. Orbital infection and rubeosis iridis
were successfully treated with scleral buckle removal, intravenous antibiotics and intracameral ranibizumab.
However, the retinal detachment recurred and the visual acuity deteriorated to light perception. There was no further
intervention as the family declined in view of her old age. In cases of recurrent orbital infection, detailed clinical
examination is important to look for evidence of ocular prostheses as a source of infection. Orbital imaging is an
adjunct for making the diagnosis especially in cases where history is unreliable. Anterior segment ischemia due to
scleral buckle responds well to buckle removal with ranibizumab injection.