Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 7

A Case of Endophthalmitis after Bilateral Medial Rectus Recession
Sagar B Patel, MD, Jennifer Cao, MD, Nick Hogan, MD, PhD
UTSW, Children’s Medical Center

Purpose: The purpose of this study is to describe a case of endophthalmitis diagnosed in a child after bilateral medial rectus recession for alternating esotropia in a 9 month old child with Down’s Syndrome.

Methods: This is a retrospective case report and literature review.

Case: A 9-month-old boy with a history of Down’s Syndrome underwent bilateral medial rectus muscle recession by an outside-hospital strabismologist. Post-operatively, this was complicated by a pyogenic granuloma which resolved with Tobradex ointment. Two weeks post-operatively he developed leukokoria of the left eye with ultrasound examination showing extensive retinal detachment, multiple areas of loculated debris with one small hyperechoic area centrally concerning for calcification within his left eye. The ophthalmologic exam was notable for a white opacity posterior to the lens with numerous undulations, necrosis, and hemorrhages in the retrolental space of the left eye. His contralateral eye was significant for multiple peripheral retinal white lesions both nasally and temporally. He underwent enucleation as we could not definitively rule out a retinoblastoma. Ocular pathology showed significant vitreous inflammation and necrosis, and an area of scleral perforation by a suture which was surrounded by inflammatory cells and adherent to the retina and vitreous.

Conclusion: Though rare, endophthalmitis is the most dreaded post-operative complication of strabismus surgery leading to devastating visual outcomes. In some instances it is not possible to conclusively differentiate retinoblastoma from endophthalmitis and in these cases given the very low visual potential of such eyes, enucleation can be a definitive and safe treatment option. Scleral perforation has been postulated as an etiology of post-strabismus endophthalmitis. This case is unique because it demonstrates a case of pediatric endophthalmitis after strabismus surgery secondary to scleral perforation as confirmed by histopathological analysis. Careful attention must be made during the scleral passage of sutures as an inadvertent scleral perforation can cause endophthalmitis.
  
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2016 Agenda and Abstracts | < Previous | Next >