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A. Lingappan, C. C. Wykoff, H. W. Flynn, Jr., D. Miller; Endogenous Fungal Endophthalmitis: Clinical Presentation and Outcome. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6033.
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The purpose of this study is to review the clinical features, microbiology, treatment strategies and visual outcomes in a large series of patients with culture-positive endogenous fungal endophthalmitis (EFE).
The authors retrospectively reviewed the microbiologic and corresponding clinical records of all patients diagnosed with EFE and treated at the Bascom Palmer Eye Institute between January 1, 1990 and July 1, 2009.
Fifty-one patients with culture-proven EFE were included. Fourteen patients had bilateral EFE. Of the 51 patients, 35 had been hospitalized within the past 6 months. The average length of hospitalization was 41 days. The most common associated medical conditions were as follows: cardiac conditions (12 patients), cancer (12), diabetes mellitus (11), immunosuppressive therapy (11), respiratory conditions (10), gastrointestinal conditions (9), intravenous line (9), intravenous drug use (6), indwelling urinary catheter (7), transplant recipient (6), HIV/AIDS (3), total parenteral nutrition (3), and hemodialysis (2). The most common causative organism was Candida albicans (33). Overall, thirty-eight patients were infected with yeast, including Candida tropicalis (3) and Cryptococcus neoformans (2). Thirteen patients were infected with mold: Aspergillus fumigatus (6), Aspergillus glaucus (2), Aspergillus niger (1), Aspergillus terreus (1), Fusarium oxysporum (2), and Cladophialophora devriesii (1). Final visual acuity was assessed for 47 patients. (In the remaining 4 patients, visual acuity could not be accurately assessed due to the patient’s age or or mental status). In patients infected with yeast, the final visual acuity was less than 5/200 E in 11 eyes (22%). In contrast, 10 eyes (67%) of patients with mold as the causative organism had vision less than 5/200 E. Furthermore, all three eyes that underwent enucleation were infected with Aspergillus.
In this series of patients with culture-proven EFE, the most common risk factor was recent hospitalization. The most common causative organism was Candida albicans. The final visual outcomes were worse in patients infected with mold versus yeast.
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