Pediatric endogenous endophthalmitis: Clinical features and treatment outcomes.

CONTEXT

Forty-eight pediatric patients treated for endogenous endophthalmitis were analyzed. Redness and vitritis were the common symptom and sign, respectively; infection with Gram-negative bacilli was frequent. Children under 5 and with systemic illness had poorer visual prognosis.

PURPOSE

To Analyze the demographics, clinical-microbiological profiles, and treatment outcomes of pediatric patients with endogenous endophthalmitis.

METHODS

We conducted a retrospective analysis of electronic medical records covering 8 years from 2016 to 2023 at a tertiary eye care center in India, focusing on patients of age <18 years diagnosed with endogenous endophthalmitis. Data extraction included demographic variables, clinical presentations, microbiological analyses, therapeutic interventions, and visual outcomes.

RESULTS

The analysis included 48 patients with an average age of 5.4 ± 4.98 years and an equal gender ratio. During the study period, 48 children with endogenous endophthalmitis were treated; it was 5% (48 of 961) of all endophthalmitis patients and 20.8% (48 of 231) of pediatric endophthalmitis patients. Common symptoms included redness (62.5%), reduced vision (20.8%), leucocoria (27.08%), pain (22.91%), and watering/discharge (29.16%). Clinical signs included vitritis (89.58%) and anterior chamber exudates/hypopyon (47.91%). Vitreous culture positivity was 54.05%; common isolates were Gram-negative bacilli (35%), Gram-positive cocci (25%), and Gram-positive bacilli and fungi (20% each). Systemic infection was present in 72.9% (35 of 48) of patients, with respiratory tract infection being the most common (39.5%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavorable outcomes were associated with Gram-positive bacilli and fungal infection. Approximately 45% of eyes worsened to phthisis.

CONCLUSIONS

Any redness in a child with systemic infection warrants prompt ophthalmic evaluation. Children under 5 with systemic illness are associated with a worse visual prognosis. Unfavorable outcomes are linked to Gram-positive bacilli and fungal infection.