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.