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Published on: February 6, 2021
Exogenous endophthalmitis in pediatric age group
Saba A Al-Rashaed1, Ahmed M Abu El-Asrar
1King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Insights
Pediatric infectious endophthalmitis is often caused by Streptococcus and Staphylococci. Early vitrectomy and nonvirulent organisms improve visual outcomes, though results remain generally poor.
Area of Science:
- Ophthalmology
- Microbiology
- Pediatric Medicine
Background:
- Exogenous infectious endophthalmitis is a severe intraocular infection.
- It can lead to significant vision loss, particularly in pediatric patients.
- Understanding the causative agents and outcomes is crucial for effective management.
Purpose of the Study:
- To determine the microbiological causes of exogenous infectious endophthalmitis in children.
- To evaluate the visual outcomes in pediatric patients with this condition.
- To identify factors influencing visual prognosis.
Main Methods:
- Retrospective review of medical records of pediatric patients (≤14 years) with culture-positive endophthalmitis.
- Data collected from King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital (1980-2004).
- Analysis of causative organisms, treatment modalities (primary vitrectomy vs. antibiotics alone), and final visual acuity.
Main Results:
- Forty-nine children were identified; 71.4% had post-traumatic endophthalmitis.
- Streptococcus species (44.6%) and coagulase-negative Staphylococci (21.4%) were the most common isolates.
- Better visual acuity was associated with nonvirulent organisms and primary vitrectomy (26% vs. 5.9% achieved counting fingers).
- Poor visual outcomes (no light perception) occurred in 29.5% of eyes, including 3 enucleations/eviscerations.
Conclusions:
- Streptococcus species and coagulase-negative Staphylococci are the predominant pathogens in pediatric infectious endophthalmitis.
- Nonvirulent organisms and prompt primary vitrectomy correlate with improved visual outcomes.
- Despite treatment, visual outcomes in pediatric infectious endophthalmitis are frequently poor.
Purpose:
To identify the microbiological spectrum and visual outcome of exogenous infectious endophthalmitis in the pediatric age group.
Methods:
We reviewed the medical records of all children 14 years and younger with culture-positive endophthalmitis treated at King Khaled Eye Specialist Hospital and King Abdulaziz University Hospital between January 1, 1980, and December 31, 2004.
Results:
Forty-nine children were identified. There were 32 males and 17 females with a mean age of 5.7 +/- 2.8 years (range 1-13 years). Thirty-five (71.4 %) cases occurred after penetrating open globe injuries and the remaining 14 (28.6%) followed ocular surgery. Primary vitrectomy was performed on 29 (59.2%) eyes. The mean follow-up was 28.4 +/- 28.4 months (range 1.2-98.5 months). A single species was isolated in 42 (85.7%) eyes, and multiple organisms in seven (14.3%) with a total of 56 infecting organisms. The most common isolates were Streptococcus species and coagulase-negative Staphylococci comprising 44.6% and 21.4% of the isolates, respectively. Final visual acuity was 20/200 or better in 15 (34.1%), counting fingers in 8 (18.2%), light perception to hand motions in 8 (18.2%), no light perception in 13 (29.5%) eyes, including 3 that have been enucleated or eviscerated, and not available in 5 patients. None of the children who had nonvirulent organisms had a final visual acuity of no light perception compared with 39.4% of children who had virulent organisms (p = 0.011). Visual outcome of counting fingers was attained in 26% of children who were treated with primary vitrectomy compared with 5.9% of children treated with antibiotics alone on presentation (p = 0.0484). Visual outcome was no light perception in 18.5% of children who underwent primary vitrectomy compared with 47.1% of children treated with antibiotics alone.
Conclusions:
The most common organisms identified were Streptococcus species and coagulase-negative Staphylococci. Culture of a nonvirulent organism, and treatment with primary vitrectomy were associated with better visual outcomes. Visual outcomes were generally poor.
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