Clinical features of neonatal endogenous endophthalmitis
Objective To observe the ocular clinical features of neonatal endogenous endophthalmitis(NEE).Methods A retrospective case series study.27 eyes of 21 newborns(12 eyes in 9 males and 15 eyes in 12 females)with NEE who visited department of ophthalmology of Sichuan Provincial People's Hospital From July2010 to July 2022were in-cluded in the study.Gestational age at birth was23～38(30±4.6)weeks.Birth weight was640～3 800(1463.6±920.4)g.All patients underwent anterior segment,fundus and laboratory examination.Clinical data such as age,sex,birth weight,gestational weeks,ophthalmic examination,laboratory examination and treatment were collected in detail.According to the ocular symptoms at the first examination,NEE was divided into the following two types:focal type,showing yellow and white localized lesions in the fundus,and fulminant type,with corneal opacity,anterior chamber exudation,hyphema as the main manifestations.The follow-up period was from 5 to 13 months,and the characteristics of eye lesions,systemic comor-bid diseases,pathogenic bacteria and treatment outcomes were observed.Results Among the 21 patients with NEE,15(71.4%)with gestational age less than 32 weeks and 16(76.2%)had a birth weight of less than 2000 g.The mean onset time was 1～20(4±4.6)weeks,and 17 cases(81%)developed NEE within 4 weeks after birth.According to the ocular symptoms at the first detection,NEE were divided into the following two types.Focal type in 2 eyes(7.4%),usually found in routine screening.The manifestation was retinal yellow white lumpy lesions.25 eyes(92.6%)of fulminant type were re-ferred to ophthalmology for treatment after obvious infection symptoms such as eyelid swelling,conjunctival injection,cor-neal opacity,and hyphema were found.The common systemic diseases of 21 patients with nee were sepsis(47.6%,10/21),meningitis(33.3%,7/21),shock(28.6%,6/21),and respiratory disturbance(23.8%,5/21).There were 19(90.5%)patients,culture positive,and the most common pathogenic bacteria was Pseudomonas aeruginosa(31.6%,6/19).Systemic antibiot-ics combined with intravitreal injection of antibiotics was the most common treatment(18 eyes,66.7%),and 12 eyes(44.4%)underwent surgery after systemic antibiotics drugs treatment.After the treatment,17 eyes(63%)of 14 patients eventually lost all vision or died.The final visual acuity of 10 eyes(27%)was preserved.Conclusions NEE usually occurs within 4 weeks after birth with corneal opacity,and hyphema is the most common ocular manifestations.The prognosis of ful-minant type is poor,and early vitrectomy combined with antibiotics may be the most effective treatment.
NewbornEndogenous endophthalmitisPseudomonas aeruginosaIntravitreal injection of antibioticsVitrectomySepsis
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