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Published on: February 6, 2021
Pediatric endophthalmitis: clinical profile, outcomes, and a proposed protocol
Georges Azar1, Pathma Thiagasorupan2, Pascal Dureau2
1Rothschild Ophthalmological Foundation, Hôpital Fondation Adolphe de Rothschild, 25 Rue Manin, 75940, Paris Cedex 19, France. gazar@for.paris.
Insights
Pediatric infectious endophthalmitis is a severe eye condition in children with poor visual outcomes, even with prompt treatment. This study proposes a management protocol to potentially improve results in these rare cases.
Area of Science:
- Ophthalmology
- Pediatric Infectious Diseases
- Microbiology
Background:
- Infectious endophthalmitis in children is a rare but sight-threatening condition.
- Prompt diagnosis and management are crucial for visual outcomes.
Purpose of the Study:
- To analyze the clinical profile and visual outcomes of pediatric infectious endophthalmitis.
- To propose an evidence-based management protocol for this condition.
Main Methods:
- Retrospective monocentric study of pediatric endophthalmitis cases (January 2008-January 2020).
- Analysis of clinical characteristics, etiology, microbiology, outcomes, and management.
- Statistical evaluation using Fischer and chi-square tests.
Main Results:
- 26 children included; mean age 4.2 years.
- Etiologies: postoperative (57.7%), posttraumatic (26.9%), endogenous (11.5%), infectious corneal ulcer (3.9%).
- Streptococcus pneumoniae was the most common pathogen (41.7%); 46.2% of eyes had phthisis bulbi; 50% had no light perception.
Conclusions:
- Pediatric infectious endophthalmitis has a generally poor visual prognosis despite aggressive treatment.
- A management protocol with adapted systemic antibiotic therapy is proposed to improve outcomes.
Purpose:
To investigate the clinical profile and visual outcomes of infectious endophthalmitis in children at a single tertiary hospital in France, and propose an evidence-based protocol for management.
Methods:
This is a retrospective monocentric study that involved children with a history of endophthalmitis between January 2008 and January 2020. The clinical characteristics, etiology, microbiological spectrum from aqueous/vitreous tab, anatomical and visual outcomes, and management were analyzed. The Fischer and chi-square tests were used in the statistical evaluation.
Results:
Twenty-six children were eligible for inclusion. The mean patients age at presentation was 4.2 years (range, 8 days-14.3 years). With regard to etiology, patients were divided into posttraumatic group (n = 7 (26.9%)), postoperative group (n = 15 (57.7%)), endogenous group (n = 3 (11.5%)), and infectious corneal ulcer group (n = 1 (3.9%)). Time-to-onset of symptoms was highest in children ≤ 3 years old and in the postoperative subgroup who had at least one glaucoma procedure. Microbiology results showed growth in 12/26 (46.2%). The most common microorganism identified was Streptococcus pneumoniae (5/12 (41.7%)). The antibiotic regimen varied depending on age, organism, and sensitivities. The final visual outcomes were 20/200 or better in 11/26 (42.3%) eyes, and 13/26 (50.0%) eyes had no light perception. Twelve of twenty-six (46.2%) eyes ended up with phthisis bulbi.
Conclusion:
Pediatric endophthalmitis is a rare but devastating condition with poor visual prognosis, requiring prompt recognition and treatment. Despite aggressive management with antibiotics and vitrectomy, the visual prognosis is generally poor. A protocol for management with an adapted systemic antibiotic therapy is proposed in order to improve outcomes.
