Acute Phthisis Bulbi in a Premature Infant

Area of Science:

• Ophthalmology
• Neonatal Medicine
• Infectious Diseases

Background:

• Premature neonates are susceptible to infections, which can lead to severe complications.
• Postpartum sepsis and meningitis, particularly with methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, pose significant risks.
• Retinopathy of prematurity screening is standard, but severe intraocular inflammation can present atypically.

Purpose of the Study:

• To report a rare case of rapidly progressing endogenous endophthalmitis in a neonate.
• To highlight the diagnostic challenges and clinical course of intraocular inflammation secondary to sepsis.
• To emphasize the potential for metaplastic changes and phthisis in the developing eye.

Main Methods:

• Clinical examination of a preterm neonate with suspected retinopathy of prematurity.
• Ophthalmic imaging including computed tomography (CT) to assess intraocular structures.
• Diagnostic enucleation of one eye and surgical intervention (lensectomy and vitrectomy) on the fellow eye.
• Microscopic examination of the enucleated eye.
• Cultures of vitreous fluid from both eyes.

Main Results:

• The neonate presented with blunted light reflexes and microphthalmia, with retrolenticular membranes obscuring fundal view.
• CT scans revealed interval development of intraocular calcifications over six weeks.
• Enucleation showed intraocular disorganization and metaplasia consistent with phthisis following inflammation.
• The fellow eye achieved light perception vision post-operatively; vitreous cultures were negative.

Conclusions:

• Untreated endogenous endophthalmitis, even when unsuspected, can cause rapid and severe metaplastic changes in the developing eye.
• Acute phthisis can be a consequence of severe intraocular inflammation secondary to systemic infection in neonates.
• This case underscores the importance of considering severe intraocular complications in neonates with sepsis and meningitis.