Purchase this article with an account.
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.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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.
This PDF is available to Subscribers Only