Pediatric Endogenous Endophthalmitis: Clinical features and treatment outcomes

Objectives: Analyse the demographic, clinical-microbiological profile, and treatment outcome of pediatric patients with endogenous endophthalmitis. Methodology: We conducted a retrospective analysis of electronic medical records covering eight years from 2013 to 2020 at a tertiary eye care centre 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. In this period, 5% of all endophthalmitis (48 of 961) and 20.8% of pediatric endophthalmitis (48 of 231) were treated. 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%), gram-positive bacilli and fungus (20% each). Systemic infection was present in 72.9% of patients; respiratory tract infection was most common (54.2%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavourable 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. Unfavourable outcomes are linked to gram-positive bacilli and fungal infection.