June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Outbreak of Fusarium endophthalmitis following Brilliant Blue G (BBG) dye-assisted vitrectomy procedures
Author Affiliations & Notes
  • Michael Davis
    Retina Institute of California, Los Angeles, CA
  • Kristie Lin
    Retina Institute of California, Los Angeles, CA
  • Tom Chang
    Retina Institute of California, Los Angeles, CA
  • Mike Samuel
    Retina Institute of California, Los Angeles, CA
  • Rizwan Bhatti
    Retina Institute of California, Los Angeles, CA
  • Steven Friedlander
    Nevada Retina Associates, Reno, NV
  • Nishita Patel
    Western University of Health Sciences, Pomona, CA
  • Pravin Dugel
    Retina Conultants of Arizona, Phoenix, AZ
  • Footnotes
    Commercial Relationships Michael Davis, Sequenom (C), Johnson and Johnson Research and Development (C), Synergetics (C), Allergan (C), Citi Financial Group (C); Kristie Lin, Janssen Pharmaceutical Companies (C), Thrombogenics (C), Sequenom (C); Tom Chang, None; Mike Samuel, None; Rizwan Bhatti, None; Steven Friedlander, None; Nishita Patel, None; Pravin Dugel, Abbott (C), Alcon (C), Allergan (C), Artic Dx (C), Alimera Sciences (C), Acucela (C), Digisight (C), Genentech (C), LUX (C), Macusight (C), Neovista (C), ORA (C), Ophthotech (C), Regeneron (C), Thrombogenics (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1110. doi:
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      Michael Davis, Kristie Lin, Tom Chang, Mike Samuel, Rizwan Bhatti, Steven Friedlander, Nishita Patel, Pravin Dugel; Outbreak of Fusarium endophthalmitis following Brilliant Blue G (BBG) dye-assisted vitrectomy procedures. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1110.

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Abstract

Purpose: To review the presentation of fungal endophthalmitis and the diagnostic dilemma it presents to the clinician, and to review the treatment regimen required to treat these resilient organisms

Methods: This is a case review of 12 patients from two locations in the Untited States afflicted with probable fungal endophthalmitis following vitrectomy surgery with BBG dye. Patient symptomatology and presentation, treatment regimens (both surgical and medical), and responses to therapy will be reviewed. Co-morbitity factors that may affect patient outcomes will also be examined.

Results: There are 12 patients from 3 Retina practices at 2 locations (further possible cases are pending) affected by a recent outbreak of Fusarium endophthalmitis. All patients underwent vitrectomy with BBG dye. The dye was compounded from a single compounding pharmacy and Fusarium was cultured from unused vials returned to the pharmacy. All patients presented with an insidious inflammation weeks after the procedure and were treated initially as both noninfectious and infectious endophthalmitis, as the presentation is not typical or consistent between cases. Most patients required further vitrectomy surgery, removal of the IOL and/or lensectomy, multiple intravitreal injections, as well as systemic antifungal medications.

Conclusions: Fungal endophthalmitis presents as both a diagnostic and treatment dilemma. Retina surgeons should have this diagnosis in their differential diagnosis when a patient presents with inflammation weeks to months after surgery. The presentation is not always typical of infectious endophthalmitis and the treatment regimen is both arduous and lengthy.

Keywords: 513 endophthalmitis  
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