Treatment patterns, outcomes and its associated factors among seasonal hyper-acute panuveitis cases in one of the largest outbreaks: a hospital-based retrospective study from Nepal.

Abstract

Introduction: Seasonal hyper-acute panuveitis (SHAPU), also called seasonal endophthalmitis is a rare rapid progressive eye disease that causes unilateral irreversible blindness predominantly in children of Nepal.  OBJECTIVE: The aim of this study is to identify treatment required and associated factors of Seasonal hyper-acute panuveitis.

Methodology: This retrospective study investigated seasonal hyper-acute panuveitis (SHAPU) cases during the largest recorded outbreak at Tilganga Institute of Ophthalmology from 2015 to 2016, involving 123 patients.

Results: A majority of cases (74%) were in individuals aged ≤18 years, with a slight male predominance (50.4%). Geographically, most patients (71.5%) came from Bagmati Province, while others came from neighbouring provinces, including one case each from Karnali and Bihar, India. At presentation, almost a quarter (24.4%) had symptoms for more than a week, 48.8% for 3-7 days and the remaining 26.8% for up to 2 days. Treatment strategies varied, with 51.2% of cases managed with intravitreal antibiotics and dexamethasone, while 48.7% required surgical intervention, including pars plana vitrectomy, often combined with lens removal, endolaser, or silicone oil or anterior vitrectomy with lensectomy (p=0.21). Fourteen cases (11.4%) were managed with endolaser with silicon oil during parsplana vitrectomy. Microbiologically, bacteria grew in 39.8% (49/123) of vitreous samples of the cases. Streptococcus pneumoniae was isolated from the vitreous of 88.6% of children and 11.4% of adults (p<0.001), while Staphylococcus aureus was exclusive to adults (p<0.001). At 3 months' post-treatment, 30.7% (27/88) of cases had visual acuity ≥6/18, improving to 46.8% (37/79) at 6 months and 58.1% (43/74) at 1 year. Better outcomes were observed in adults, eyes with vitreous culture negative status, clear vitreous tap, cases not requiring pars plana vitrectomy, and those with Staphylococcus aureus isolation. Outbreak timing, gender, symptom duration, and oral steroid use did not significantly impact the outcome. Overall, favourable outcomes increased over time, with some exceptions.

Conclusion: Vitreous culture result shows that 39.8% of SHAPU cases have bacteria inside their eyes. Treatment outcome indicates that even the culture negative SHAPU cases are consistent with bacterial endophthamitis of severe type. One reason why children with SHAPU do worse that adult is the type of bacteria these eyes are infected with. With prompt and proper treatment of SHAPU, the visual recovery is significant.