Intraocular foreign body injury in children: clinical characteristics and factors associated with endophthalmitis

Yang, Yao; Yang, Chengcheng; Zhao, Ruijuan; Lin, Lei; Duan, Fang; Lou, Bingsheng; Yuan, Zhihang; Lin, Xiaofeng

doi:10.1136/bjophthalmol-2019-314913

Cited by 16 publications

(13 citation statements)

References 33 publications

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“…Similarly, our study found that over 85% of injuries occurred at home were mostly self-inflicted, and that scissors were the leading cause of injuries (28.6%). Zone I was the most common wound entry site, and traumatic cataract presented as the common sign in our study, consistent with previous studies on paediatric post-traumatic endophthalmitis [ 1 , 21 ].…”

Section: Discussionsupporting

confidence: 92%

“…Previous studies on paediatric ocular trauma found that the proportion of males was close to that of females in younger children and increased with age [ 19 – 21 ]. Preschool patients aged 0–6 years were included in our study, and the proportion of males was close to that of females (57.1% vs. 42.9%), consistent with the findings of previous studies.…”

Section: Discussionmentioning

confidence: 99%

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Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes

Yang

Sui

Duan

et al. 2021

Eye

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Background/Objectives Streptococcus is a common cause of post-traumatic endophthalmitis in children. This study aimed to analyse the clinical features, antibiotic susceptibilities and outcomes of traumatic endophthalmitis caused by streptococcus in preschool children. Subjects/Methods Patients aged ≤6 years with traumatic streptococcal endophthalmitis seen at Zhongshan Ophthalmic Center between January 2013 and December 2018 were included in this retrospective study. Results In total, 21 patients (21 eyes) were included. The mean age of the patients was 3.3 ± 1.7 years, where 57.1% were males. Scissors (28.6%, n = 6) were the most common cause of injury; 86.7% of patients were injured at home. Zone I (80.9%) was the most common wound site; 90.5% of patients presented with a traumatic cataract. In general, Streptococcus pneumoniae (47.6%) was the most common isolate. Viridans group streptococci accounted for 58.3% of cases in children aged 0–3 years, while S. pneumoniae accounted for 66.7% of cases in children aged 4–6 years. The susceptibility rates of streptococcus to cefuroxime, levofloxacin and ofloxacin were 100%, 95.0% and 90.5%, respectively. Although all the patients underwent vitrectomy combined with silicone oil tamponade, the final visual outcomes were no better than counting fingers. Conclusions Although S. pneumoniae was the most prevalent organism in general, the dominant species varied between different age groups. The commonly used antibiotics, cefuroxime and fluoroquinolone, showed higher antibiotic susceptibility. Despite prompt treatment, the visual outcomes of paediatric post-traumatic endophthalmitis in preschool children were poor.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes

Yang

Sui

Duan

et al. 2021

Eye

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“…In our study, the proportion of posttraumatic endophthalmitis (85.0%) among children was much higher than adult-dominated population reported from the same region (58.0-58.5%) [15,23]. The higher proportion of traumatic endophthalmitis in the pediatric population could be explained by that fact that children are generally unable to either recognize or explain their symptoms after injury, thereby resulting in delayed presentation and treatment, leading to a higher incidence of endophthalmitis [24].…”

Section: Discussioncontrasting

confidence: 51%

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Yang

Lin

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To analyze the etiology, microbiological isolates, and antibiotic susceptibilities of endophthalmitis in pediatric patients. Methods Patients aged < 18 years with culture-positive endophthalmitis in Zhongshan Ophthalmic Center between January 2010 and December 2018 were included retrospectively. Results A total of 127 patients (127 eyes) were included, and 108 (85%) had posttraumatic endophthalmitis. Streptococcus (21.4%), coagulase-negative Staphylococcus (14.5%), Aspergillus (6.9%), and Bacillus cereus (5.3%) were the common organisms. The proportion of Streptococcus decreased with age (40.0% in 0-3 years, 16.3% in 4-12 years, and 6.3% in 13-17 years), while coagulase-negative Staphylococcus increased from 5.7% to 18.8%. Overall, fluoroquinolones achieved the highest antibiotic susceptibility rate (> 95%), while the susceptibility of isolated bacteria to tobramycin and cefazolin was only 60.2% and 59.4%, respectively. The susceptibility rates of Gram-positive cocci to cephalosporins were nearly 90%. For Gram-negative bacilli, susceptibility to neomycin was 91.3%. Conclusion Trauma was the main etiology for pediatric endophthalmitis. Although Streptococcus was the most prevalent organism in general, the dominant pathogen varied with age, which merits clinical attention. Fluoroquinolones showed the highest antibiotic efficacy; however, commonly used antibiotics tobramycin and cefazolin showed relatively low antibiotic susceptibility. Thus, antibiotic resistance in pediatric populations merits clinical attention.

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“…Intraocular cilium have been reported to be asymptomatic for 50 year in the anterior chamber [ 11 ]. However, more reports have shown that cilia left in eyes tend to cause polytype endophthalmitis [ 1 , 2 ]. Therefore, the cilia, especially with follicle found accidentally in the operation, should be taken out at the same time if possible.…”

Section: Discussionmentioning

confidence: 99%

“…An intraocular foreign body is present in 18–41% of open-globe injuries [ 1 ] and is the key factor for visual outcome when removing an intraocular foreign body. Cilia is a type of small autogenic biological intraocular foreign body that is difficult to detect by auxiliary equipment prior to surgery, especially when located at the posterior ocular segment [ 2 ], and can lead to infective endophthalmitis or uveitis [ 3 ]. It was also a key factor leading to intraocular infection after intraocular foreign body removal surgery.…”

Section: Introductionmentioning

confidence: 99%

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma

Zha

Wang

et al. 2021

Med Sci Monit

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Background The aim of this study was to analyze the value of ocular endoscopy in detecting and extracting intraocular cilia in patients with ocular trauma. Material/Methods We retrospectively analyzed data on identification and extraction of 46 intraocular cilia in 16 eyes with open-globe injury during endoscope-assisted vitrectomy. Results A total of the 16 patients with open-globe injury were operated on from September 2002 to June 2019. The cornea in 14 eyes was cloudy. Two eyes had endophthalmitis and 13 eyes had retinal detachment. A total of 46 cilia were extracted through direct observation under the ocular endoscope during vitrectomy 1 to 68 weeks after injury. The number of cilia per eye varied from 1 to 10. Most of the cilia were located in or near the wound. Postoperative IOP was normal in 14 patients. The follow-up after surgery showed hypotony in only 2 eyes (7.2 and 5.8 mmHg, respectively). Compared with preoperative intraocular pressure, there was a statistically significant difference. The postoperative visual acuity improved in 12 eyes and remained unchanged in 3 eyes. The vision after surgery was significantly improved compared with that before surgery ( P =0.006). The intraocular pressure increased significantly after operation ( P <0.001). And no glaucoma or retinal detachment or endophthalmitis was found. No eyes needed additional vitreous surgery. Conclusions Ocular endoscopy allows surgeons to detect intraocular cilia that were no undetected by CT or B-ultrasound preoperatively in time and to extract them effectively. It improves performance of vitrectomy in the presence of a cloudy cornea and also prevents exogenous endophthalmitis. The vision of patients with ocular trauma was improved.

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Intraocular foreign body injury in children: clinical characteristics and factors associated with endophthalmitis

Cited by 16 publications

References 33 publications

Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes

Post-traumatic endophthalmitis caused by streptococcus species in preschool children: clinical features, antibiotic susceptibilities and outcomes

Etiology, microbiological isolates, and antibiotic susceptibilities in culture-proven pediatric endophthalmitis: a 9-year review

Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma

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