The incidence, clinical features, microbiology, and visual outcomes of endophthalmitis associated with glaucoma surgery in children

Abstract

Purpose: To study the incidence, clinical features, microbiology, and visual outcome of endophthalmitis associated with glaucoma surgery in children at a tertiary care eye hospital in Saudi Arabia. Methods: The medical records of patients <18 years of age who presented with endophthalmitis following glaucoma surgery between January 2008 and October 2018 were reviewed retrospectively. Results: Endophthalmitis after glaucoma surgery was observed in 20 eyes, or 18 out of 853 eyes that underwent glaucoma surgery at our institution (2.1%; 3.3% for glaucoma drainage device [GDD] surgery and 0.9% for glaucoma filtration surgery [GFS]). The mean patient age at time of endophthalmitis was 5.2 ± 4 years (range, 1-15 years). Delayed endophthalmitis (developing at least 6 weeks after surgery) occurred in 13 of the 20 eyes (65%). The median interval between glaucoma surgery and the development of endophthalmitis was shorter after GDD surgery (59 days; range, 26-1325) compared with GFS (606 days; range, 20-2190). Visual outcome was generally poor, with counting fingers or worse in 14 of 20 eyes (70%). A causative organism was identified in 16 of 20 eyes (80%) either through a vitreous tap or vitrectomy specimen, and the most cultured organism was Streptococcus pneumoniae (45%). Conclusions: In our study cohort, the incidence of endophthalmitis after GFS was 0.9% and 3.3% after GDD implant surgery; the incidence was higher than previously reported in adults, with poor long-term visual prognosis in the pediatric age group.