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Outcomes of Post-Traumatic Pediatric Endophthalmitis Following 25-Gauge Pars Plana Vitrectomy
Insights
Early 25-gauge pars plana vitrectomy (PPV) significantly improves vision and resolves infection in children with post-traumatic endophthalmitis. This approach offers favorable structural and functional outcomes, even in severe cases.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Infectious Diseases
Background:
- Post-traumatic endophthalmitis in children presents a significant challenge to vision preservation.
- Open globe injuries are a common cause of endophthalmitis in pediatric populations.
Purpose of the Study:
- To evaluate the structural and functional outcomes of 25-gauge pars plana vitrectomy (PPV) in pediatric patients diagnosed with post-traumatic endophthalmitis.
Main Methods:
- A retrospective study analyzed 33 children (mean age 6.5 years) who underwent 25-gauge PPV for post-traumatic endophthalmitis.
- Preoperative data included visual acuity, presence of hypopyon, intraocular foreign body, and retinal detachment.
- Surgical details and microbiological results were recorded, with a minimum follow-up of 3 months.
Main Results:
- Mean time to PPV was 5.8 days post-injury; 81% required pars plana lensectomy (PPL).
- Best-corrected visual acuity (BCVA) improved from 2.6 to 1.3 logMAR (p<0.001), with 33.3% achieving vision of 3/60 or better.
- Anatomical success (retinal attachment) was 72.7%, and endophthalmitis resolution was 90%.
Conclusions:
- Early 25-gauge PPV demonstrates favorable structural and functional outcomes in pediatric post-traumatic endophthalmitis.
- Timely vitrectomy, appropriate tamponade, and indicated lensectomy are crucial for achieving high rates of infection resolution and retinal attachment.
Aim:
To evaluate the structural and functional outcomes of 25-gauge pars plana vitrectomy (PPV) in children with post-traumatic endophthalmitis.
Material And Methods:
This retrospective study included 33 children (mean age: 6.5 ±2.6 years) with endophthalmitis following open globe injury who underwent 25G PPV. Preoperative parameters recorded were age, gender, time of onset, best-corrected visual acuity (BCVA), hypopyon, intraocular foreign body (IOFB), and retinal detachment (RD). Surgical details noted included timing of PPV, intraoperative findings, lens status, tamponade, and need for pars plana lensectomy (PPL). Vitreous samples were taken for microbiology. Minimum follow-up was 3 months.
Results:
The mean interval between injury and onset of endophthalmitis was 4.72 ±3.75 days, and the mean time to PPV was 5.8 ±4.7 days. Hypopyon was present in 45.4%, IOFB in 12.1%, and RD in 6.1%. PPL was performed in 81% of eyes. Mean preoperative BCVA was 2.6 ±0.2 logMAR, improving significantly to 1.3 ±0.5 logMAR at 3 months (p 3/60) was achieved in 33.3%. Anatomical success with retinal attachment was achieved in 72.7%, and endophthalmitis resolution in 90%. Retinal reintervention was required in 15%. Oil tamponade was used in 30% and gas in 9.1%. Microbiological positivity was seen in 39.3%, most commonly Gram-positive cocci.
Conclusion:
Early 25G PPV in pediatric post-traumatic endophthalmitis offers favorable structural and functional outcomes. High rates of infection resolution and retinal attachment can be achieved despite severe presentation, particularly with timely vitrectomy, tailored tamponade, and lensectomy when indicated.
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