Abstract
Introduction: :
Objective: To study the incidence of endogenous fungal endophthalmitis or chorioretinitis in patients with systemic fungemia confirmed with positive blood culture.
Design: :
Retrospective review of 64 eyes of 32 patients with fungemia and examined by the inpatient ophthalmology consultation service between August 1, 2006 and October 31, 2009.
Methods: :
Ophthalmic examination was performed within 48 hours of positive blood culture. It consisted of visual acuity (when possible), external examination with Heine hand-held slit lamp of anterior segment and dilated indirect ophthalmoscopy. Examinations performed by residents and confirmed by attendings.
Results: :
Thirty-two patients with systemic fungal infection. None had ocular symptoms although 3 of 32 patients were intubated and unconscious and/or sedated at the time of examination. There were 34.3% females (11/32) and 65.7% males (21/32) in this study. Age ranged between 3 and 62 years old. The incidence of fungal endophthalmitis in our study was 0%. 2 patients demonstrated significant posterior segment findings including chorioretinal scarring in one eye and vitreous syneresis in another eye. All thirty-two patients were receiving systemic antifungal therapy. Risk factors for development of endogenous fungal endophthalmitis were: 1) History of recent antibiotic therapy (78.1%. 25/32), 2) immunosuppression (53.1% 17/32), 3) indwelling line (12.5% 4/32), and 4) liver disease (6.25% 2/32). All patients had at least one of these risk factor.
Conclusions: :
Endogenous fungal endophthalmitis has been described to be a relatively frequent complication of nosocomial systemic fungal infections. In previous reports, the incidence ranges from 2.8% to 40%. We are reporting an incidence of 0% in 32 patients examined during this time frame. This could be explained by the prompt initiation of systemic antifungal therapy. In our study population, all patients were on antifungal therapy at the time of examination. The risk factors for endogenous fungal endophthalmitis are well known and they were present in our patients. The limitation in our study is population size. Despite the fact that the incidence in this series is low, dilated fundus exam is still recommended.
Keywords: fungal disease • clinical (human) or epidemiologic studies: prevalence/incidence • vitreous