A retrospective study was conducted to investigate the cause, clinical characteristics and treatment outcomes of paediatric endogenous endophthalmitis in Vietnam. The study included 157 patients (53% male) with mean age of 6.0 ±3.8 years. Average duration from symptom onset to hospital admission was 4.9 ±5.1 days and 88% were hospitalised within 7 days on symptom onset. Rate of accurate diagnosis was 22.6% and misdiagnosis included uveitis, conjunctivitis and keratitis. Aqueous samples were obtained in 113 cases of which 59% tested positive for organisms. Vitreous samples were obtained in 75 cases of which 77% tested positive for organisms. Gram-positive cocci were the most common causative agents followed by gram-negative bacilli. Gram-positive bacilli, fungi and mixed infections were rare. There was no significant difference for occurrence in right or left eyes, and there were no bilateral cases. No systemic disease was present in 89%. Visual acuity could be tested in 90 patients: 85.6% had visual acuity of counting fingers or worse. Corneal damage was present in 89%; keratitic precipitates in 7%. All had anterior chamber signs: 74.5% with anterior focal hypopyon, pupil exudates in 43% and posterior synechiae in 21%. Fifty percent could be assessed for lens clarity and 30% were clear. Vitreous assessment was possible for 46.5% and all had significant vitreous haze. Retinal detachment occurred in 9%. Functional success from treatment occurred for 36.7% and anatomical success in 64.3%. Prognostic factors included duration of symptoms before admission, blurred visual acuity, vitreous opacity grade and timing of vitrectomy. Presentation within 7 days had significantly higher anatomical success as did visual acuity better than light perception, less vitreous haze and less severe vitreous opacity. If significant deterioration occurred, or no improvement following initial treatment with intravitreal antibiotic injection, pars plana vitrectomy was performed and found to give promising outcomes with higher functional and anatomical success rates. Overall, paediatric endogenous endophthalmitis accounted for 12.4% of endopthalmitis cases.
Children profile of endogenous endophthalmitis in Vietnam
Reviewed by Fiona Rowe
Endogenous endophthalmitis in children: a 5-year retrospective study in Vietnam.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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