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J. K. Kim, Q. V. Hoang, P. J. Pahk; Intraocular Candidiasis Incidence and Response to Treatment in an Inpatient Setting. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2904.
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Endogenous intraocular fungal infection is a complication of fungemia that can have vision-threatening consequences. As such, fundus examination for a fungemic patient is a commonly requested ophthalmic consultation in the inpatient setting. In this study, we report the incidence and speciation of endogenous intraocular fungal infections in an inpatient tertiary care center and assess the responses to various treatments.
Inpatient ophthalmology consultation requests at the Mount Sinai Medical Center between July 2009 - November 2009 for fungemia were retrospectively reviewed. Patients were examined by indirect ophthalmoscopy, and active fungal chorioretinitis was defined as the presence of a focal, white, infiltrative lesion without any vitreous involvement. Fungal endophthalmitis was defined as the presence of chorioretinitis plus vitreous extension or the presence of intravitreal focal white lesions with ill-defined borders. Patients diagnosed with intraocular fungal infection received a course of an antifungal agent and were periodically re-examined by the ophthalmology service until resolution.
Thirty-one patients with candidemia were examined for intraocular involvement, of which seven were found to have intraocular candidiasis. Six patients had Candida chorioretinitis, and one patient had Candida endophthalmitis. Four out of the seven cases were caused by Candida albicans. Other species identified were C. glabrata, C. parapsilosis, and C. tropicalis. Three patients with C. albicans were successfully treated with fluconazole. One patient with C. albicans progressed while on fluconazole and developed bilateral fungal endophthalmitis. He received intravitreal amphotericin to which he responded poorly. Subsequently he received intravitreal voriconazale to which he responded. The patients with C. glabrata and C. tropicalis chorioretinitis received caspofungin, after which their lesions resolved.
In contrast to recent studies citing decreasing rates of intraocular candidiasis (<2%, 7%), the present study found the incidence of intraocular candidiasis in candidemic patients to be 23%. Additionally, despite several studies questioning the vitreous penetration of systemic caspofungin, in our patients there was resolution of chorioretinitis while on the medication. Last, in a treatment-resistant Candida strain, intravitreal voriconazole was effective.
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