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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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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
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.
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.
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.
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