Abstract
Introduction
Paediatric endophthalmitis is a severe but rare complication of intraocular surgery, penetrating trauma and far less commonly extra-ocular surgery or endogenous origin. We set out to establish the incidence and risk factors of exogenous endophthalmitis in children, and to develop an evidence-based protocol that can be used for treatment of suspected exogenous endophthalmitis in children.
Methods
Microbiology reports and operation numbers were obtained from two large tertiary referral hospitals sharing 24-h paediatric ophthalmology cover for the period January 2009–December 2016. All cases of aqueous and/or vitreous tap performed on children aged ≤18 years were identified and case notes reviewed for complete information on each case.
Results
Sixteen cases were eligible for inclusion as ‘postoperative endophthalmitis’: complete data was found on 13 cases. The incidence of postoperative endophthalmitis was 0.17% over 7 years.
The mean age of presentation was 5.5 years (range from 7 months to 16 years and 9 months), from 3 days-78 months post operatively. In all, 11/13 had at least one glaucoma procedure. Microbiology results showed growth in 8/13. Most isolates were Gram-positive bacteria but Gram-negatives were also isolated and in one case Candida from a conjunctival swab. The antibiotic regime varied depending on age, organism identified and sensitivities. In all, 9/13 had hand movement or worse vision after treatment.
Conclusion
Paediatric endophthalmitis may present to any paediatric/general ophthalmologist. It is a rare but devastating condition with poor visual prognosis, requiring prompt recognition and aggressive management. Previous glaucoma surgery is a long-term risk factor in our local paediatric population. Based on our study, an evidence-based protocol for management is proposed in order to improve outcomes.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Clavell C, Athwal L, Zarbin MA, Langer PD, Bhagat N. Pediatric infectious endophthalmitis: a case series. J Pedia Ophthalmol Strabismus. 2018;55:69–70.
Alfaro DV, Roth DB, Laughlin RM, Goyal M, Liggett PE. Paediatric post-traumatic endophthalmitis. Br J Ophthalmol. 1995;79:888–91.
Agarkar S, Desai R, Jambulingam M, Sumeer SH, Raman R. Incidence, management, and visual outcomes in pediatric endophthalmitis following cataract surgery by a single surgeon. J Aapos. 2016;20:415–8.
Wu H, Ding X, Zhang M, Xu G. Pediatric posttraumatic endophthalmitis. Graefes Arch Clin Exp Ophthalmol. 2016;254:1919–22.
Junejo SA, Ahmed M, Alam M. Endophthalmitis in paediatric penetrating ocular injuries in Hyderabad. J Pak Med Assoc. 2010;60:532–5.
Thordsen JE, Harris L, Hubbard GB 3rd. Pediatric endophthalmitis. A 10-year consecutive series. Retina. 2008;28(3 Suppl):S3–7.
Khan S, Athwal L, Zarbin M, Bhagat N. Pediatric infectious endophthalmitis: a review. J Pedia Ophthalmol Strabismus. 2014;51:140–53.
Zhang M, Xu GZ, Jiang R, et al. Pediatric infectious endophthalmitis: a 271-case retrospective study at a single center in China. Chin Med J (Engl). 2016;129:2936–43.
Ranganath A, Hashim. A Late-onset endophthalmitis secondary to exposed glaucoma tube implant in a rare case of paediatric glaucoma. 2011. Case Rep Ophthalmol Med. https://doi.org/10.1155/2011/183647.
Recchia FM, Baumal CR, Sivalingam A, Kleiner R, Duker JS, Vrabec TR. Endophthalmitis after pediatric strabismus surgery. Arch Ophthalmol. 2000;118:939–44.
Gharaibeh AM, Mezer E, Ospina LH, Wygnanski-Jaffe T. Endophthalmitis following pediatric cataract surgery: an International Pediatric Ophthalmology and Strabismus Council Global Perspective. J Pedia Ophthalmol Strabismus. 2018;55:23–29.
Zloto O, Mezer E, Ospina L, Stankovic B, Wygnanski-Jaffe T. Endophthalmitis following strabismus surgery: IPOSC Global Study. Curr Eye Res. 2017;42:1719–24.
Donachie PHJ, Sparrow JM. National Ophthalmology Database Audit Year 2 Annual Report 2017. Royal College of Ophthalmologists. Accessed 30th Nov 2017. https://www.rcophth.ac.uk/standards-publications-research/annual-reports-2.
Rahi JS, Dezateaux C. Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a National Study of Congenital Cataract in the UK. IOVS. 2001;42:1444–8.
Bradbury JA. What information can we give to the patient about the risks of strabismus surgery. Eye. 2015;29:252–7.
Golde KT, Gardiner MF. Bacterial conjunctivitis in children: a current review of pathogens and treatment. Int Ophthalmol Clin. 2011;51:85–92.
Beck AD, Wilson WR, Lynch MG, Lynn MJ, Noe R. Trabeculectomy with adjunctive mitomycin C in pediatric glaucoma. Am J Ophthalmol. 1998;126:648–57.
Sidoti PA, Belmonte SJ, Liebmann JM, Ritch R. Trabeculectomy with mitomycin-C in the treatment of pediatric glaucomas. Ophthalmology. 2000;107:422–9.
Gedde SJ, Scott IU, Tabandeh H, et al. Late endophthalmitis associated with glaucoma drainage implants. Ophthalmology. 2001;108:1323–7.
Krishna R, Godfrey DG, Budenz DL, et al. Intermediate-term outcomes of 350-mm(2) Baerveldt glaucoma implants. Ophthalmology. 2001;108:621–6.
Morad Y, Donaldson CE, Kim YM, Abdolell M, Levin AV. The Ahmed drainage implant in the treatment of pediatric glaucoma. Am J Ophthalmol. 2003;135:821–9.
Al-Torbak AA, Al-Shahwan S, Al-Jadaan I, Al-Hommadi A, Edward DP. Endophthalmitis associated with the Ahmed glaucoma valve implant. Br J Ophthalmol. 2005;89:454–8.
Weinstein GS, Mondino BJ, Weinberg RJ, Biglan AW. Endophthalmitis in a pediatric population. Ann Ophthalmol. 1979;11:935–43.
Wells AP, Cordeiro MF, Bunce C, Khaw PT. Cystic bleb formation and related complications in limbus—versus fornix-based conjunctival flaps in pediatric and young adult trabeculectomy with mitomycin C. Ophthalmology. 2003;110:2192–7.
Jayaram H, Scawn R, Pooley F, et al. Long-term outcomes of trabeculectomy augmented with mitomycin C undertaken within the first 2 years of life. Ophthalmology. 2015;122:2216–22.
Ciulla TA, Beck AD, Topping TM, Baker ASBlebitis. early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery. Ophthalmology. 1997;104:986–95.
Han DP, Wisniewski SR, Wilson LA, et al. Spectrum and susceptibilities of microbiologic isolates in the Endophthalmitis Vitrectomy Study. Am J Ophthalmol. 1996;122:1–17.
Campochiaro PA, Conway BP. Aminoglycoside toxicity-a survey of retinal specialists. Implic Ocul use Arch Ophthalmol. 1991;109:946–50.
Morlet N, Graham GG, Gatus B, et al. Pharmacokinetics of ciprofloxacin in the human eye: a clinical study and population pharmacokinetic analysis. Antimicrob Agents Chemother. 2000;44:1674–9.
Brockhaus L, Goldblum D, Eggenschwiler L et al. Revisiting systemic treatment of bacterial endophthalmitis: a review of intravitreal penetration of systemic antibiotics. Clin Microbiol Infect. 2019. https://doi.org/10.1016/j.cmi.2019.01.017. [Epub ahead of print]
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
MT is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS or the NIHR. The funding organizations had no role in the design or in conducting this research. The remaning authors declare that have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Parvizi, S., Papadopoulos, M., Panteli, V. et al. Paediatric endophthalmitis: a UK retrospective study. Eye 34, 553–561 (2020). https://doi.org/10.1038/s41433-019-0546-4
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/s41433-019-0546-4
This article is cited by
-
The UK practice of Anti-VEGF therapy for treatment of retinopathy of prematurity
Eye (2021)
-
Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)
