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Pediatric endophthalmitis: clinical profile, outcomes, and a proposed protocol

  • Inflammatory Disorders
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Abstract

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.

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Authors and Affiliations

  1. Rothschild Ophthalmological Foundation, Hôpital Fondation Adolphe de Rothschild, 25 Rue Manin, 75940, Paris Cedex 19, France

    Georges Azar, Pathma Thiagasorupan, Pascal Dureau, Gilles Martin, Catherine Edelson, Florence Metge & Georges Caputo

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  1. Georges Azar
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  2. Pathma Thiagasorupan
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  3. Pascal Dureau
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  4. Gilles Martin
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  6. Florence Metge
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  7. Georges Caputo
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Correspondence to Georges Azar.

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Azar, G., Thiagasorupan, P., Dureau, P. et al. Pediatric endophthalmitis: clinical profile, outcomes, and a proposed protocol. Graefes Arch Clin Exp Ophthalmol 259, 3405–3412 (2021). https://doi.org/10.1007/s00417-021-05340-8

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  • DOI: https://doi.org/10.1007/s00417-021-05340-8

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