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Jayanth Sridhar, Harry Flynn, Darlene Miller, Thomas Albini; Endogenous Endophthalmitis caused by Molds: Risk Factors, Management Strategies, and Visual Acuity Outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1126. doi: https://doi.org/.
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To report the risk factors, management strategies, and visual acuity (VA) outcomes in patients with culture-proven endogenous endophthalmitis caused by molds.
A non-comparative consecutive case series of all patients with culture-proven unilateral or bilateral endogenous endophthalmitis caused by molds at the Bascom Palmer Eye Institute between January 1, 1990 and December 31, 2011
Study criteria were met in 15 eyes of 13 patients. Patients had a mean follow-up of 10.8 months from presentation to last follow-up visit. Risk factors included current or recent hospitalization (69.2%), iatrogenic immunosuppression (61.5%), and cardiac disease (53.8%). In the affected eyes decreased vision was the most common presenting symptom (93.3%) followed by redness (66.7%) and pain (40.0%). 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 (66.7%). Hypopyon was noted in 33.3% of affected eyes. The most common organism cultured by vitreous aspirate or vitrectomy specimen was Aspergillus fumigatus (46.2%) followed by Fusarium oxysporum (15.4%) and Aspergillus glaucus (15.4%). Non-ocular cultures were positive in 15.4% of patients. Initial treatment with pars plana vitrectomy (PPV) was performed in 46.7% of eyes. During the course of treatment, 93.3% of eyes received systemic treatment consisting of either oral or intravenous antifungal therapy. 60% of eyes received intravitreal injection of an antifungal agent. 80% of eyes underwent PPV, with or without lensectomy. VA on presentation was >=20/200 in 21.4% of eyes. VA >=20/200 was present in the same 21.4% of eyes at last follow-up. Retinal detachment occurred in 13.3% of eyes. During the course of treatment enucleation was performed in 26.7% of eyes.
In this study of endogenous endophthalmitis caused by molds, Aspergillus fumigatus was the predominant etiology. Common risk factors included recent hospitalization and iatrogrenic immunosuppression. The majority of patients in this study underwent PPV during the course of treatment. Endogenous endophthalmitis caused by molds is associated with poor visual acuity outcomes despite early and appropriate management.
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