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J.E. Thordsen, L. Harris, B. Hubbard; Pediatric Endophthalmitis: 10 Year Retrospective Review . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4095.
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Purpose: To report the etiology, culture results, management techniques and visual outcomes for pediatric endophthalmitis at our institution for the past 10 years. Methods: Retrospective chart review (based on computer generated database) of all cases of endophthalmitis occurring in patients younger than 18 years from 1995 to present. Information extracted from each chart included the following: (1) patient's age, sex, and race; (2) precipitating event; (3) vitreous culture results; (4) treatment regimen; (5) performance of secondary surgical procedures (6) final visual acuity. Results:Sixteen cases of pediatric endophthalmitis were identified. Patient age ranged from 3 months to 16 years (mean 6.8 years) and included 10 males and 6 females. Seven cases (44%) were secondary to penetrating ocular trauma, with three of them involving IOFB. Six cases (38%) were associated with previous ocular surgery (four had prior trabeculectomy, one had strabismus surgery, and one had an Ahmed valve placement). Of the six postoperative endophthalmitis cases, four occurred within one month of ocular surgery. Of the three remaining cases of endophthalmitis, two were endogenous and one was secondary to a perforated corneal ulcer. Nine of 16 cases were diagnosed and treated within 48 hours of developing symptoms. Nine eyes (56%) had positive vitreous cultures. The vitreous cultures grew Streptococcal species in 4 cases, Haemophilus influenzae in 3 cases, and Staphylococcal species in 2 cases. All patients were treated with intravitreal antibiotics or antifungals. In addition, 14 patients received intravenous antibiotics and/or antifungals. Vitrectomy was performed in 9 eyes. Seven eyes developed retinal detachments within 5 weeks of being diagnosed and treated for endophthalmitis. At last follow–up, visual acuity (Va) of 20/400 or better was obtained in 6 eyes (38%). Three patients (19%) had final Va of hand motion/count fingers, one patient had final Va of light perception and six patients (38%) had no light perception. Conclusions: Pediatric endophthalmitis in this series most commonly resulted from penetrating ocular trauma or from ocular surgery. Streptococcal species and Haemophilus influenzae were the most frequent causative organisms. Retinal detachment occurred as a complication of endophthalmitis in over half the cases. Despite aggressive management with antibiotics and in many cases vitrectomy, visual outcomes were poor in this series.
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