Pediatric Endogenous Endophthalmitis: A Decade of Surgical Management and Microbiological Insights

Purpose: To analyze the clinical profile, surgical management, and outcomes of patients with pediatric endogenous endophthalmitis over a decade at a tertiary eye care center in South India. Methods: This retrospective study included 32 eyes of 32 children younger than 15 years. Demographics, systemic illness, microbiological profile, surgical intervention, and outcomes were evaluated. Statistical analysis assessed the relationship between risk factors, complications, and outcomes. Results: The mean age was 7.5 ± 4.4 years; 17 patients were male, and 17 cases involved the right eye. Systemic illness or intravenous therapy preceded infection in 18 patients (56%). In all cases, surgery was performed within 48 hours of presentation. All eyes underwent pars plana vitrectomy with intravitreal antibiotics and intravitreal antifungal agents. Based on intraoperative assessment and the surgeon's discretion, silicone oil tamponade was used in 16 eyes. Good functional outcomes (best-corrected visual acuity >20/400) occurred in 37.5% of patients, while favorable anatomic outcomes were seen in 46.9%. Median vision improved significantly from hand motions to 20/2400 (P < .05). Ocular complications were seen in 53.1%, including retinal detachment (7 eyes), secondary glaucoma (2 eyes), and phthisis bulbi (5 eyes), which were significantly associated with poor outcomes (P < .05). Unique organisms identified included Pantoea agglomerans, Burkholderia cepacia, Rothia dentocariosa, Serratia marcescens, and Alternaria. Conclusions: In this study, pediatric patients with endogenous endophthalmitis had significant visual morbidity despite appropriate surgical intervention. Early vitrectomy aids anatomic recovery, but ocular complications remain the main determinants of unfavorable outcomes.