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Post-traumatic endophthalmitis in 143 eyes of children and adolescents from India
E Rishi1, P Rishi1, V V Koundanya1
1Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, India.
Insights
Post-traumatic endophthalmitis in children, often caused by organic matter injuries, requires prompt treatment. Early vitrectomy significantly improves outcomes for pediatric patients with this severe eye infection.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Trauma Surgery
Background:
- Post-traumatic endophthalmitis (PTE) is a severe intraocular infection following eye trauma.
- Pediatric cases present unique challenges in diagnosis and management.
- Understanding risk factors and prognostic indicators is crucial for optimizing patient outcomes.
Purpose of the Study:
- To delineate the clinical spectrum of PTE in pediatric patients.
- To identify risk factors, common causative organisms, and treatment strategies.
- To evaluate outcomes and factors influencing them in children and adolescents with PTE.
Main Methods:
- Retrospective interventional case series.
- Review of 143 pediatric eyes with PTE from 1997-2007.
- Univariate and multivariate analyses to determine factors associated with adverse outcomes.
Main Results:
- Mean age was 9.2 years; broomstick and needle injuries were common.
- Cataract, hypopyon, and retinal detachment were frequent presentations.
- Corneal abscess and retinal detachment independently predicted poor outcomes (OR 5, P<0.05).
- Gram-positive bacteria, particularly E. fecalis, were common.
- Early treatment (<24h) and vitrectomy significantly improved anatomical outcomes (P<0.0001).
Conclusions:
- PTE in children is often linked to organic matter injuries and affects younger boys.
- Corneal abscess and retinal detachment are poor prognostic indicators.
- Prompt surgical intervention, especially early vitrectomy, is vital for favorable outcomes in pediatric PTE.
Purpose:
The purpose of this study was to describe clinical features, risk factors, causative organisms, treatment options, and outcomes of post-traumatic endophthalmitis in children and adolescents.
Methods:
Retrospective interventional case series. Case records of 143 consecutive eyes presenting with post-traumatic endophthalmitis between 1997 and 2007 were reviewed. Univariate and multivariate analysis were done to analyze factors associated with adverse outcomes.
Results:
Mean age at presentation was 9.2 years (median 8 years, range: 2 months to 18 years). Broomstick and hypodermic needle were most common causes for injuries. Common presenting features were cataract (n=51), hypopyon (n=45) and retinal detachment (n=29). Corneal abscess (n=21; OR: 5, CI: 1.4-18.7) and retinal detachment (n=29, OR: 5, CI: 1.6-11.3) were independent risk factors for poor outcome (P=0.04 and 0.012, respectively). Gram-positive bacteria were isolated in 54% (n=31) of culture-positive cases. Forty-nine (34%) patients had ambulatory vision at final visit. Patients who received treatment within 24 h were 3.6 and 9 times more likely to have better anatomical outcome than those treated at 2-7 days, or >7 days, respectively (P=0.0001). Patients undergoing early vitrectomy were 27 times more likely to have better outcome (P=0.0001).
Conclusion:
Post-traumatic endophthalmitis in children is more common in boys <10 years of age and most often caused by injury with organic matter. Corneal abscess and retinal detachment are associated with poor outcome. E. fecalis is the most common causative organism. Early vitrectomy results in better outcomes.
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