PEDIATRIC POSTTRAUMATIC ENDOPHTHALMITIS IN TAJIKISTAN

Abstract

Objective: Study the clinical and epidemiological patterns of posttraumatic endophthalmitis (PTE) in children in Tajikistan. Methods: Retrospective-prospective analysis of PTE cases in children (aged up to 15 years), was carried out based on data from ophthalmologic institutions of the Republic of Tajikistan providing emergency care to children with eye injuries for the period from 1993 to 2003 and 2010 to 2018. All patients were divided into the following groups: 1st group – children with PTE referred in 1993-2003 (n=152), 2nd group – children with PTE referred in 2010-2018 (n=81), PTE group – all children with PTE as a result of open globe injury (OGI) from the 1st and 2nd groups (n=225), OGI group – all children with OGI without subsequent development of PTE in both indicated time periods (n=1794). Results: During the study period, 233 (6.4%) of PTE cases were detected among 3,590 children with ocular trauma (3,652 eyes), where incidence of PTE in children with OGI was 11.1%, and with closed globe injury (CGI) - complication of posttraumatic corneal ulcers – 0.5%. PTE developed 2.1 times more frequently in boys than in girls and 3.8 times more likely in a rural than urban settings. The prevailing age group was 4-6 years, accounting for 34.7% of cases. There was no statistically significant difference between the 1st and 2nd groups in terms of the incidence of PTE, demographic indicators and clinical features, except decreased frequency of intraocular foreign bodies (IFB) in the 2nd group. Delayed patient’s presentation and wounds in the cornea and sclera were associated with higher risk of PTE development in the patients with OGI, while hemorrhage in the eye cavity, choroid prolapse and lens injury had lower risk of PTE. Visual acuity (VA) in PTE patients upon discharge was distributed as follows: absence of light perception was observed in 22.2% of the eyes, light perception/VA = 0.04 – in 29.8%, VA ≥0.05 – in 11.6% of cases. The removal of the eyeball was performed in 6% of observations. The phthisis of the eyeball was significantly more common in the eyes with PTE (4.9%). Conclusion: The incidence of pediatric PTE remains stable in both study periods, the risk factors for PTE development after OGI are delayed patient’s presentation and penetrating injury of the cornea and sclera. Application of intravitreal injections of antibiotics during the surgical debridement (SD) of OGI reduces the risk of PTE.

Keywords

• pediatric posttraumatic endophthalmitis
• ocular trauma
• open globe injury.