Endophthalmitis incidence and clinical features in a pediatric ophthalmologic

tertiary hospitalJaume Català Mora, MD

Gemma Gelabert Colomer, PhD. Jesús Díaz Cascajosa, MD

Sandra Gómez Sánchez, MDJoan Prat Bartomeu, MD, PhD

Introduction & Objective

• Pediatric non traumatic endophthalmitis is a rare intraocular infection that leads to blindness in a high percentage of cases

• Hospital Sant Joan de Déu:– Tertiary pediatric hospital in Barcelona– Ophthalmology department:

• 4000 first-visits/year• 13.625 successive-visits• 1000 surgeries/year.

Objective & Methods

• Objective: retrospective study of non traumatic endophthalmitis cases attended in our institution the last 10 years (2001-2011)

• Retrospective review of patient’s chart: – 1) age and gender– 2) etiology & involved eye– 3) initial treatment– 4) culture results– 5) final visual acuity, additional procedures & status of the eye

• Ocular fluid specimens and wound cultures were obtained aseptically in the operating room and sent to microbiology for gram stain, culture, and sensitivity testing

Surgical procedures/year *:postop endophtalmitis case

The overall incidence of postoperative endopthalmitis in our hospital is 0.04 %

Case Age/Sex Etiology/Eye Initial Tx Culture Final VA;status

1 10m/F Strabismus/RE Intravitreal S.epidermidisNo LP/eviscerated

2 18m/M Goniotomy/LE Intravitreal S.pneumoniae HM/Phaco+IOL

3 4y/FSuture extraction/LE

Intravitreal S.pneumoniae HM/vitrectomy

4 11m/F Ahmed valve/LE Intravitreal S.pneumoniae LP/vitrectomy

5 4y/M Lensectomy/LE Intravitreal No growth 20/30; IOL

6 & 7 10d/M Endogenous/OU Vitrectomy P.aeruginosa HM/LP

Summary of endophthalmitis cases

Discussion• Endophthalmitis in pediatric patients is a rare event. The incidence

in our hospital is 4/10000 surgeries

• Intraocular surgery is at greater risk of endophthalmitis although it can also happen after strabismus surgery, especially in case of penetrating sutures

• Despite the early and the aggressive treatment: intravitreous injections of ceftazidime & vancomicine, endovenous antibiotics and vitrectomy when needed the visual prognosis is still poor

• Intravitreal antiVEGF treatment is an expanding treatment in children. Although we have not had any case of endophthalmitis post intravitreal injection in infants this risk should be considered and balanced in the management of this patients

BibliographyThordsen JE, Harris L, Hubbard GB. Pediatric endophthalmitis: a 10 year consecutive series.

Retina 2008; 28: S3-S7

Huang S, Crawford B, Rutar T. Pathological findings in poststrabismus surgery endophthalmitis. JAAPOS 2011; 15: 98-100

THANK YOU