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Kenneth Warren Price, Edmund Tsui, Lisa Park, Irene A Barbazetto; Inpatient Ophthalmology Consults for Fungemia at an Urban Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5518.
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There is currently much debate about the utility of routine ophthalmology consults to rule out intraocular involvement in fungemic patients, especially in the age of modern antifungals with improved ocular penetration. This retrospective observational clinical study aims to evaluate the incidence of intraocular involvement in patients with fungemia and identify predisposing risk factors in our population at an urban tertiary care hospital.
A retrospective review was performed using clinical records for all inpatient ophthalmology consults for ‘fungemia’, ‘candidemia’, and ‘rule out fungal endophthalmitis’ between the dates of January 1, 2010 and December 31, 2015.
Of 94 patients (51.6 years, 75.5% male) with fungemia, 9/94 (9.6%) had chorioretinal involvement with one patient (1.1%) developing vitreous opacities. Another five (5.3%) demonstrated non-specific retinal lesions of which an infectious etiology could not be ruled out but were deemed inactive due to failure to progress over multiple examinations. Of those diagnosed with intraocular involvement, no patients communicated visual disturbances as they were either asymptomatic or intubated. 7/9 (78%) had a history of intra-abdominal surgery within the past year, 6/9 (67%) were receiving total parenteral nutrition (TPN), and 6/9 (67%) had concomitant bacteremia. All fungal isolates were subspecies of Candida with C. albicans being the most common (found in 6/9 patients [67%]). Change in management due to intraocular findings occurred in 2/9 cases (22%) and consisted mainly of optimization of antimicrobial therapy.
Ocular involvement in fungemia is uncommon, but if present may result in devastating visual loss. In this study, an incidence of 9.6% is consistent with prior reports. However, in our series, all patients with intraocular involvement were asymptomatic or unable to communicate suggesting that routine examination remains necessary to detect early changes and modify treatment as necessary. These results also suggest that risk factors for ocular involvement in fungemia include history of abdominal surgery, total parenteral nutrition and concomitant bacteremia.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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