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H. J. Simonsz, M. Swart-van den Berg, M. P. M. ten Tusscher, M. J. van Schooneveld, L. Missotten, G. H. Kolling, K. U. Löffler, L. Hansen, C. M. Mooy, A. A. H. J. Thiadens; Thirteen Cases of Endophthalmitis or Retinal Detachment After Strabismus Surgery: Very Young or Very Old. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4876.
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The incidence of endophthalmitis or retinal detachment after strabismus surgery is low, but their consequences are devastating. After it occurred in a two-year-old girl at the Erasmus Medical Center, communication about additional cases enabled us to study characteristics, risk factors and incidence rate.
After the index case occurred, other pediatric ophthalmologists in the Netherlands, Belgium and Germany were contacted. A questionnaire was developed by defining circumstances, that were discussed in a focal group and categorized into six domains pertaining to history, surgery, scleral perforation, postoperative measures and experts' opinion. The resulting data were discussed during a plenary meeting of orthoptists and ophthalmologists, including those who contributed cases (co-authors of this study).
Ten additional cases of endophthalmitis and two cases of retinal detachment after strabismus surgery were contributed. Patients were either under eight (n=8) or over 65 years (n=4, including 2 retinal detachments) of age, or had had previous cataract surgery (n=3). Twelve occurred after recession, one after myopexia. In the endophthalmitis cases, scleral perforation preceding the endophthalmitis was unlikely. For instance, the two-year-old girl presented with a complete medial rectus palsy that resolved with antibiotics and a retinal detachment was found neither with ultrasonography nor at vitrectomy. Concentration and use of povidone-iodine as preoperative antisepsis varied.
Endophthalmitis after strabismus surgery occurs after recession in very young or very old patients, or after previous cataract surgery. The relation between perforation and endophthalmitis is weak. It seems possible that bacterial infection surrounds the suture and bacteria penetrate the eye through channels for vessels and nerves in the sclera. To clarify the optimal concentration and use of povidone-iodine in young children, a randomized controlled trial has been started.
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