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Jayanth Sridhar, Harry W. Flynn, Jr., Darlene Miller, Thomas Albini; Endogenous Endophthalmitis caused by Yeast: Risk Factors, Management Strategies, and Visual Acuity Outcomes. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1677.
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To report the risk factors, management strategies, and visual outcomes in patients with culture-proven endogenous endophthalmitis caused by yeast.
A non-randomized consecutive case series of all patients with culture-proven unilateral or bilateral endogenous endophthalmitis caused by yeast at the Bascom Palmer Eye Institute between January 1, 1990 and September 30, 2011
Study criteria were met in 51 eyes of 39 patients. Patients had a mean follow-up of 16.7 months from presentation to last follow-up visit.Decreased vision was the most common presenting symptom (74.3%) followed by redness (46.1%) and pain (38.5%). 65.8% of patients had a current or recent (< 6 months) hospitalization at the time of diagnosis. Recent surgery was the most common identified risk factor (31.6%) followed by cancer (23.7%). None of the patients were diagnosed on routine screening for fungemia.Diffuse anterior and posterior inflammation was the most common finding on examination of affected eyes (64.7%) followed by focal posterior inflammation (23.5%). Hypopyon was noted in only 5.8% of affected eyes.Initial treatment consisted of a combination of medical and surgical treatment in 33.3% of eyes. 37.2% of eyes received medical treatment consisting of systemic antifungal therapy, intravitreal injection of antifungals, or both. 43.1% of eyes underwent vitrectomy with or without lensectomy, with or without intravitreal injection.The most common organism cultured by vitreous aspirate or vitrectomy specimen was Candida albicans (87.2%) followed by Candida tropicalis (7.7%) and Cryptococcus neoformans (5.1%). Blood cultures were positive in 17.9% of patients.Visual acuity on presentation was 20/200 or better in 41.3% of eyes. Visual acuity of 20/200 or better was present in 61.3% of eyes at last follow-up. Retinal detachment occurred in 29.4% of eyes.
In this study of endogenous endophthalmitis caused by yeast, Candida albicans was the predominant etiology. Decreased vision was the most common presenting symptom. Endogenous endophthalmitis is associated with poor visual acuity outcomes despite early and appropriate management. Retinal detachment is a frequent event in the clinical course.
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