April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Age-Related Immune Defects Causing Endophthalmitis After Strabismus Surgery in Young Children or in Elderly
Author Affiliations & Notes
  • H. J. Simonsz
    Erasmus Medical Center, Rotterdam, The Netherlands
  • M. R. Batstra
    Immunology, Reinier de Graaf Hospital, Delft, The Netherlands
  • C. M. Mooy
    Erasmus Medical Center, Rotterdam, The Netherlands
  • W. B. van Leeuwen
    Medical Microbiology and Infectious Diseases,
    Erasmus Medical Center, Rotterdam, The Netherlands
  • K. U. Löffler
    University Eye Clinic, Bonn, Germany
  • N. G. Hartwig
    Erasmus Medical Center, Rotterdam, The Netherlands
  • Footnotes
    Commercial Relationships  H.J. Simonsz, None; M.R. Batstra, None; C.M. Mooy, None; W.B. van Leeuwen, None; K.U. Löffler, None; N.G. Hartwig, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 1134. doi:
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      H. J. Simonsz, M. R. Batstra, C. M. Mooy, W. B. van Leeuwen, K. U. Löffler, N. G. Hartwig; Age-Related Immune Defects Causing Endophthalmitis After Strabismus Surgery in Young Children or in Elderly. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1134.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : We previously reported (ARVO 07) on 14 cases of endophthalmitis after strabismus surgery. These were either children under 6 who underwent a medial rectus recession and had a poor outcome, or elderly over 65 who had been operated previously on the involved eye and had a favorable outcome. We sought for age-related differences in immune response that could underlie the 2 distinct presentations.

Methods: : The index case was a 2-year-old girl with a previous right abducens palsy after otitis media with 41.9°C. An encapsulated, mucoid H. influenzae was cultured from the vitreous and, after enucleation 2 years later, from purulent discharge of the socket. Homology was examined with multi locus sequence typing (MLST). Her immune response and that of 3 other children and 2 elderly were assessed. Specifically, Pneumococcus IgG type 1, 3, 4, 5, 9 and 23 (against bacterial capsular polysaccharides) were measured. Enucleated eyes of the index case, of 2 other children and 1 elderly were studied histopathologically.

Results: : MLST showed that the 2 strains of H. influenzae from the index case were not related: 6 of 7 alleles were different. She had had no retinal detachment until vitrectomy 3 weeks later. Pathology showed no perforation: the deeper layers of the sclera were undisturbed. Underneath the suture tract the channel for the long posterior ciliary artery was located, however. Levels of all 6 types of Pneumococcus IgG were < 0.35 ug/ml (2 out of 6 may be considered normal). A 12-year-old boy, operated at 4, had 4 types < 0.35 ug/ml; his eye is phtysic. A 6-year-old girl, operated at 3, had 2 types and a 16-year-old boy, operated at 2, had 3 types < 0.35 ug/ml; both enucleated phtysic eyes had an area of transscleral scarring compatible with perforation. A 65-year-old woman had 2 types and a 71-year-old man had 1 type < 0.35 ug/ml, scleral perforation had occurred in both cases.

Conclusions: : The type of endophthalmitis after strabismus surgery that occurs in young children can be caused, in part, by immune defects of the type that resolves when the IgG armentarium unfolds. A contaminated suture may then cause it even without scleral perforation. Although the immune response against capsular polysaccharides decays in senescence, we could not detect this in 2 elderly cases. As all 8 cases in young children originated from medial rectus recessions and some had had upper respiratory infections, the possibility of reflux from the lacrimal sac needs further study.

Keywords: strabismus • strabismus: treatment • bacterial disease 

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