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H. W. Flynn, Jr., N. Z. Gregori, D. Miller, I. U. Scott, J. L. Davis, T. G. Murray; Candida Endophthalmitis Following Cataract Surgery: Management Strategies, and Visual Acuity Outcomes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):679.
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To report the clinical presentation, management, and visual acuity outcomes in patients with Candida endophthalmitis following cataract surgery.
Retrospective consecutive case series. The Bascom Palmer Eye Institute Microbiology Laboratory database was reviewed to identify all patients with intraocular cultures positive for Candida between 1980-2006. Clinical records were reviewed to identify those patients who developed Candida endophthalmitis following cataract surgery.
Five patients were identified. Four had cataract surgery with posterior chamber intraocular lens (IOL); one underwent combined penetrating keratoplasty, cataract surgery, and anterior chamber intraocular lens implantation(IOL). Endophthalmitis developed 7-60 days postoperatively (median, 14 days) and patients were followed 7-48 months after presentation (median, 24 months). Presenting vision ranged between 20/200 and counting fingers. Examination demonstrated whitish material on the IOL in four patients and within the cataract wound in one. Four patients experienced persistent or recurrent infection despite intravitreal and systemic antifungal treatment. All patients were treated initially with intravitreal amphotericin B and pars plana vitrectomy; four received oral antifungal agents; four underwent IOL removal. Final vision ranged from 20/25 to light perception. A final acuity ≥ 20/50 was achieved in 2 patients and was < 5/200 in 2 patients.
When clinical features include whitish material on the IOL, lens capsule, or within the cataract wound, Candida should be included in the differential diagnosis of early-onset or delayed-onset endophthalmitis following cataract surgery. Initial pars plana vitrectomy, intravitreal antifungal injection, and oral antifungal medications may not achieve resolution of the infection . In the current series, after IOL explantation in eyes with recurrent disease, the infection resolved but visual acuity outcomes were variable.
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