Paediatric Endophthalmitis: Incidence and Management
Sahar Parvizi1,2, FRCOphth; Vasiliki Panteli2, FRCOphth; Gill A. Adams1, FRCOphth; Maria Theodorou1, FRCOphth
Moorfields Eye Hospital
Great Ormond Street Hospital
Introduction: Paediatric endophthalmitis is a severe but rare complication of intraocular surgery, penetrating trauma, and far less commonly extra-ocular surgery and endogenous.
We set out to establish the incidence and risk factors of endophthalmitis in children, and to develop a clear protocol that can be used for treatment of suspected endophthalmitis.
Methods: Microbiology reports and operation numbers were obtained from two large tertiary referral hospitals sharing 24-hour paediatric ophthalmology cover for the period January 2009 – December 2016. All cases of aqueous and/or vitreous tap performed on children aged </=16 years were identified and case notes reviewed for complete information on each case.
Results: 15 cases were eligible for inclusion as ‘postoperative endophthalmitis’: complete data was found on 12 cases. The incidence of postoperative endophthalmitis was 0.0025 over 7 years.
The mean age of presentation was 4.5years (range 7months-11yrs 9months), from 3days-21months post op. 10/12 had at least 1 glaucoma procedure. Microbiology results showed growth in 8/12 with most being gram positive organisms, but also including fungus. The antibiotic regime varied depending on age, organism identified and sensitivities. 9/12 had hand movement or worse vision after treatment.
Discussion: Paediatric endophthalmitis is a rare but devastating condition with poor visual prognosis which may present to any paediatric/general ophthalmologist. It requires prompt treatment. Previous glaucoma surgery is a longterm risk factor in children.
Conclusion: Based on our audit and a literature review, a protocol and pathway for management is proposed in order to improve outcomes.
References: Al-Rashaed SA, El-Asrar AMA. Exogenous Endophthalmitis in Pediatric Age Group. Ocular Immunology and Inflammation (2006);14:5,285-292