Abstract
Purpose: :
To report the fungal isolates, treatment strategies and clinical outcomes of patients with exogenous fungal endophthalmitis (EFE).
Methods: :
Clinical records were reviewed for all patients treated at Bascom Palmer Eye Institute between January 1, 1990 and June 30, 2006 for culture-proven EFE. IRB approval was obtained.
Results: :
Culture positive EFE occurred in 41 eyes of 41 patients, including 18 cases (44%) associated with advanced fungal keratitis, 10 cases (24%) following penetrating ocular trauma, 12 cases (29%) after intraocular surgery and one case (2%) after glaucoma filtering surgery. Filamentous fungi (molds) accounted for 35 cases (85%) including 13 due to Fusarium and 8 due to Aspergillus. Candida species (yeasts) accounted for 6 cases (15%). As initial treatment, 30 patients (73%) received intraocular amphotericin B. Amphotericin B was used intraocularly one or more times in 88% of cases and at least 3 antifungal agents were used in 24 cases (59%). At least one pars plana vitrectomy was performed in 25 eyes (61%) and 29 eyes (71%) underwent 3 or more procedures, including surgeries and intraocular injections. A final vision of 20/400 or better was achieved in 22 eyes (54%) with 18 (44%) achieving a final vision of 20/80 or better. Ten eyes (24%) were enucleated with 8 (80%) enucleations being performed within one month of diagnosis of endophthalmitis.
Conclusions: :
In the current study, the most common isolates were molds (85%) in particular Fusarium and Aspergillus. Amphotericin B was used intraocularly one or more times in 88% of cases and 59% were treated with at least 3 different antifungal agents. Visual outcomes following treatment are variable and range from 20/20 to NLP.
Keywords: endophthalmitis • fungal disease • trauma