Endophthalmitis after pediatric strabismus surgery.
OBJECTIVE
To report 6 cases of endophthalmitis after pediatric strabismus surgery.


METHODS
Retrospective review of initial signs, clinical findings, treatment, culture results, and visual and anatomical outcomes in 6 eyes of 6 children treated at 2 tertiary care institutions between 1983 and 1998.


RESULTS
Four boys and 2 girls aged 8 months to 6 years (median age, 2 years) developed lethargy and asymmetric eye redness, with or without eyelid swelling or fever, within 4 days of surgery. At diagnosis (median, postoperative day 6) clinical findings included periorbital swelling, redness and leukocoria due to vitritis, and, in some cases, hypopyon. Treatment included pars plana vitrectomy and intravitreal and systemic antibiotics in all cases. Vitreous cultures grew Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Within 6 months of strabismus surgery, visual acuity was no light perception in all eyes and 3 eyes had been enucleated. The 3 remaining eyes were prephthisical.


CONCLUSIONS
Endophthalmitis after pediatric strabismus surgery is rare. Children may not recognize or verbalize symptoms. Causative organisms are virulent. Visual and anatomical outcomes are poor. Lethargy, asymmetric eye redness, eyelid swelling, or fever in the postoperative period, even if initial postoperative examination results are normal, should prompt urgent ocular examination. The diagnosis of endophthalmitis may be made when biomicroscopic or indirect ophthalmoscopic examination confirms the presence of vitreous opacification with or without hypopyon. Arch Ophthalmol. 2000;118:939-944
Recchia
F M
FM
Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107, USA.
Baumal
C R
CR
Sivalingam
A
A
Kleiner
R
R
Duker
J S
JS
Vrabec
T R
TR
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013285:Strabismus / Q000601:surgery*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000900:Anti-Bacterial Agents