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Published on: February 6, 2021
Pediatric Infectious Endophthalmitis: A 271-case Retrospective Study at a Single Center in China
Meng Zhang1, Ge-Zhi Xu1, Rui Jiang1
1Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.
Insights
Pediatric infectious endophthalmitis, often caused by ocular trauma, leads to poor visual outcomes in children despite aggressive treatment. Common pathogens include Staphylococcus and Streptococcus species.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Pediatric infectious endophthalmitis is a severe, sight-threatening condition in children.
- Understanding its causes, microbial agents, and outcomes is crucial for effective management.
Purpose of the Study:
- To investigate the etiology, microbiological spectrum, and visual outcomes of pediatric infectious endophthalmitis.
- To analyze clinical characteristics and management strategies at a single institution in China.
Main Methods:
- Retrospective study of 271 pediatric patients (<14 years) with infectious endophthalmitis (2009-2015).
- Analysis of medical records, including clinical data, microbiology, and visual outcomes.
- Statistical evaluation using Kappa and Chi-square tests.
Main Results:
- Ocular trauma (94.8%) was the primary cause; Staphylococcus and Streptococcus species were the most common pathogens.
- Positive cultures were found in 54.2% of cases, with Gram-positive organisms predominating (80.8%).
- Poor visual outcomes (20/200 or worse) occurred in 61.2% of eyes; 3.3% required enucleation/evisceration.
Conclusions:
- Penetrating ocular trauma is the leading cause of pediatric endophthalmitis in China.
- Despite treatment, visual prognosis remains generally poor, highlighting the severity of this condition.
- Different microbial profiles exist for exogenous versus endogenous endophthalmitis.
Background:
Pediatric infectious endophthalmitis is a serious sight-threatening disease for children. The purpose of this study was to investigate the etiology, microbiological spectrum, and visual outcomes of infectious endophthalmitis in children at a single institution in China.
Methods:
It is a retrospective study of the medical records of all patients under 14 years of age with histories of infectious endophthalmitis, treated at a single institution from January 1, 2009 to January 1, 2015. The clinical characteristics, etiology, microbiological spectrum, and management, as well as the visual outcomes, were analyzed. The Kappa test and Chi-square test were used in the statistical evaluation.
Results:
A total of 271 children were identified, with a mean age of 5.61 ± 2.93 years (range 5 months to 14 years). Ocular trauma (94.8%) and previous ocular surgery (3.0%) were the most common etiologies. Overall, 147 (54.2%) cases had positive cultures, and 176 organisms were isolated from these patients. A single species was isolated in 120 (81.6%) cases, with multiple organisms in 27 (18.4%) cases, and the most commonly identified organisms were coagulase-negative Staphylococcus and Streptococcus species, comprising 29.5% and 26.8% of the isolates, respectively. Moreover, of 176 isolates, 142 (80.8%) were Gram-positive organisms, 23 (13.0%) were Gram-negative organisms, and 11 (6.2%) were fungi. The final visual outcomes were 20/200 or better in 66 (24.4%) eyes, counting fingers to 20/200 in 34 (12.5%), hand motions in 30 (11.1%), light perception in 33 (12.2%), no light perception in 32 (11.8%), and 9 (3.3%) eyes were enucleated or eviscerated. The visual outcomes were not available in 67 (24.7%) patients.
Conclusions:
Penetrating ocular trauma is the most frequent cause of pediatric endophthalmitis in China. Streptococcus and Staphylococcus species are the most commonly identified organisms in exogenous pediatric endophthalmitis whereas Fusarium species are commonly seen in endogenous endophthalmitis. In this research, in spite of aggressive management with antibiotics and vitrectomy, the visual prognosis was found to be generally poor.
