September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Demographics, Clinical Characteristics, Risk Factors, Management, and Outcomes of Culture Positive Fungal Endophthalmitis; A 10-Year Case Series at University Hospital
Author Affiliations & Notes
  • Neil Patel
    Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Xintong Li
    Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Ahmed Sheikh
    Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Marco A Zarbin
    Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Neelakshi Bhagat
    Ophthalmology & Visual Sciences, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Footnotes
    Commercial Relationships   Neil Patel, None; Xintong Li, None; Ahmed Sheikh, None; Marco Zarbin, None; Neelakshi Bhagat, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6379. doi:
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      Neil Patel, Xintong Li, Ahmed Sheikh, Marco A Zarbin, Neelakshi Bhagat; Demographics, Clinical Characteristics, Risk Factors, Management, and Outcomes of Culture Positive Fungal Endophthalmitis; A 10-Year Case Series at University Hospital. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6379.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Fungal endophthalmitis continues to be a serious intraocular infection that threatens vision, yet due to its relative rarity, there is little information in the established literature about its presentation and optimal treatment methods. The goal of this retrospective chart review study was to analyze cases of both exogenous and endogenous fungal endophthalmitis to help shed light on patient demographics, clinical presentation, management, and outcome.

Methods : An IRB approved retrospective chart review spanning 2005-2015 was conducted on culture positive fungal endophthalmitis cases. Patient demographics, cause of infection, infiltrating organism, past medical/ocular history, and treatment courses were recorded.

Results : Of 13 eyes identified, 9 were exogenous cases and 4 were endogenous. Exogenous etiology included traumatic injury, post-operative infection, and post-infectious keratitis; in endogenous cases, 1 was due to IV drug abuse. Candida albicans and Fusarium were equally the most common infecting organisms in exogenous endophthalmitis and Candida albicans was the most common in endogenous endophthalmitis. The other organisms included Aspergillus fumigatus, Epicoccum, Rhodotorula mucilaginosa, and Scopulariopsis. The average presenting visual acuity (VA) of exogenous patients was in the LP-HM range while endogenously infected individuals presented with a mean VA of 20/200. Intravitreal injection of either amphotericin or voriconazole with or without pars plana vitrectomy was administered in all exogenous cases (except enucleated eyes). Voriconazole was the most common intravenous (IV) and only oral antifungal treatment administered. Exogenous patients received IV antifungals for an average of 10.6 days and endogenous for 8.5 days respectively. All were discharged on oral antifungals. The average best VA achieved was ∼HM in exogenous cases and ∼20/80 in endogenous cases. Vision of no light perception was seen in 2/9 (22%) of exogenous cases versus 0/4 endogenous cases. Enucleation was performed in 4 eyes (3 exogenous).

Conclusions : Candida was the most common organism overall. Exogenous fungal endophthalmitis cases can be severe with a higher enucleation risk and poorer visual prognosis.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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