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Endophthalmitis in full term neonates presenting as the diagnostic feature of septicemia

Session Details

Session Title: Vitreo Retinal Surgery I

Session Date/Time: Thursday 11/09/2014 | 08:00-10:00

Paper Time: 09:20

Venue: Auditorium

First Author: : S.Ganesan INDIA

Co Author(s): :    T. Sharma              

Abstract Details

Purpose:

Neonatal endophthalmitis presenting as the diagnostic feature for identifying septicemia in otherwise healthy babies are extremely rare presentations . This study aims to assess the clinical profile , etiology and discuss the risk factors for the development of endophthalmitis in the neonates presenting to a tertiary eye care centre.

Setting:

hospital

Methods:

Retrospective chart review of 6029 neonates in a tertiary referral eye care centre from January 2000 to December 2013 was performed who underwent complete ophthalmic evaluations which included anterior segment examination with hand held slit lamp, perkin’s applanation tonometry , dilated retinal examination with indirect ophthlamoscopy and scleral depression. Complete information about the birth history, course in NICU , details of septicemia work up and maternal risk factors were documented.

Results:

Endophthalmitis was diagnosed in 3 out of 6029 neonates (0.04%). Case1: 21 days old 39wk male child weighing 2.75kg born by normal delivery with premature rupture of membranes(PROM) of 4 hours presented with inflammatory changes and and yellow reflex in the left eye. Ultrasonography showed increased choroidal thickness and Positive ‘T’ sign . PPV and lensectomy was performed with intravitreal vancomycin, ceftazidime and decadran. Blood and vitreous culture revealed staphylococcus aureus. Systemic antibiotics were given in NICU . 2 intravitreal injections quietened the eye to pthisis in 15 days. Case2: 7 day old 41wk male weighing 2.5kg delivered by LSCS presented with inflammation and yellow reflex. Ultrasonography revealed multiple vitreous echoes. Aqueous tap revealed Candida species. 3 Intravitreal Voriconazole was given. Vitreous exudates cleared and post subcapsular cataract developed at 2 when lensectomy was performed Case3: 5 day old 39wk male delivered by breech weighing 3.00kg of GDM mother with 6 hours of PROM presented with AC inflammation. Ultrasonography revealed detached retina, increased choroidal thickness and ‘T’ sign. Aqueous tap revealed Bacillus species. Blood culture and vaginal swab was positive for E.Coli . A total of 2 Intravitreal injection of vancomycin, ceftazidime and decadran lead to pthisis in 18 days

Conclusions:

Neonatal endophthalmitis in term infants with good birth weight are rare . Endophthalmitis alone can also be the only presenting feature of septicemia . Neonatal fungal endophthalmitis had good anatomical and visual outcome compared to bacterial infections. Neonatal endophthalmitis are sensitive to all available drugs in our armamentarium. Premature rupture of membranes in term babies was identified as a significant risk factor in bacterial endophthalmitis. Neonatologists in NICU should be aware of this risk factor and a very prompt referral not only can salvage the eye but can have best visual and anatomic outcomes.

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