Ahead of print

Original article

Outcomes of Post-Traumatic Pediatric Endophthalmitis Following 25-Gauge Pars Plana Vitrectomy

Ashish Markan ORCID
Abha Gupta ORCID – Manasi Tripathi ORCID – Vipin Rana ORCID – Mohit Dogra ORCID – Divya Chauhan ORCID – Deeksha Katoch ORCID – Simar Rajan Singh ORCID – Reema Bansal ORCID – Vishali Gupta ORCID – Ramandeep Singh ORCID – Basavaraj Tigari ORCID

Full Text links

Keywords: pediatric endophthalmitis, pars plana vitrectomy, trauma, vitreoretinal surgery, visual outcomes

Summary

Aim: To evaluate the structural and functional outcomes of 25-gauge pars plana vitrectomy (PPV) in children with post-traumatic endophthalmitis.

Material and Methods: This retrospective study included 33 children (mean age: 6.5 ±2.6 years) with endophthalmitis following open globe injury who underwent 25G PPV. Preoperative parameters recorded were age, gender, time of onset, best-corrected visual acuity (BCVA), hypopyon, intraocular foreign body (IOFB), and retinal detachment (RD). Surgical details noted included timing of PPV, intraoperative findings, lens status, tamponade, and need for pars plana lensectomy (PPL). Vitreous samples were taken for microbiology. Minimum follow-up was 3 months.

Results: The mean interval between injury and onset of endophthalmitis was 4.72 ±3.75 days, and the mean time to PPV was 5.8 ±4.7 days. Hypopyon was present in 45.4%, IOFB in 12.1%, and RD in 6.1%. PPL was performed in 81% of eyes. Mean preoperative BCVA was 2.6 ±0.2 logMAR, improving significantly to 1.3 ±0.5 logMAR at 3 months (p < 0.05). Functional success (ambulatory vision > 3/60) was achieved in 33.3%. Anatomical success with retinal attachment was achieved in 72.7%, and endophthalmitis resolution in 90%. Retinal reintervention was required in 15%. Oil tamponade was used in 30% and gas in 9.1%. Microbiological positivity was seen in 39.3%, most commonly Gram-positive cocci.

Conclusion: Early 25G PPV in pediatric post-traumatic endophthalmitis offers favorable structural and functional outcomes. High rates of infection resolution and retinal attachment can be achieved despite severe presentation, particularly with timely vitrectomy, tailored tamponade, and lensectomy when indicated.

References

  1. Bansal P, Venkatesh P, Sharma Y. Posttraumatic Endophthalmitis in children: Epidemiology, Diagnosis, Management, and Prognosis. Semin Ophthalmol. 2018 Feb 17;33(2):284-292.
  2. Li X, Zhou Y, Chen Z, et al. Clinical Characteristics, Pathogen Distribution, and Factors Affecting Visual Outcomes of Pediatric Post-Traumatic Endophthalmitis. Antibiotics. 2025 Jan;14(1):20.
  3. Zhou YL, Wang YX, Yao TT, Yang Y, Wang ZY. Traumatic endophthalmitis and the outcome after vitrectomy in young children. Int J Ophthalmol. 2020;13(3):406-411.
  4. Venkatesh R, Dave AP, Gurav P, Agrawal M. Post-traumatic endophthalmitis in children. Nepal J Ophthalmol. 2019 Jan;11(21):55-63.
  5. Altan T, Kapran Z, Eser I, Acar N, Unver YB, Yurttaser S. Comparative outcomes of pars plana vitrectomy in acute postoperative endophthalmitis with 25-gauge and 20-gauge techniques. Jpn J Ophthalmol. 2009 Sep;53(5):506-511.
  6. Yang Y, Sui W, Duan F, et al. Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes. Eye Lond Engl. 2022 Jan;36(1):95-101.
  7. Rishi E, Rishi P, Koundanya VV, Sahu C, Roy R, Bhende PS. Post-traumatic endophthalmitis in 143 eyes of children and adolescents from India. Eye. 2016 Apr;30(4):615-620.
  8. Dehghani A, Ghanbari H, Akhlaghi M, et al. Pediatric endophthalmitis-associated penetrating ocular trauma: A single-center retrospective study. Oman J Ophthalmol. 2025 Apr;18(1):4.
  9. Yehezkeli V, Hare I, Moisseiev E, Assia EI, Chacham I, Ela-Dalman N. Assessment of long-term visual outcomes in aphakic children wearing scleral contact lenses. Eye. 2023 Feb;37(3):421-426.
  10. Okhravi N, Adamson P, Lightman S. Use of PCR in endophthalmitis. Ocul Immunol Inflamm. 2000 Sep;8(3):189-200.
  11. Ercanbrack CW, Rahal DA, Chauhan MZ, Jabbehdari S, Uwaydat SH. Utility of pan-bacterial and pan-fungal PCR in endophthalmitis: case report and review of the literature. J Ophthalmic Inflamm Infect. 2024 Aug 1;14(1):37.