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C. C. Wykoff, H. W. Flynn, Jr., D. Miller, I. U. Scott, E. C. Alfonso; Exogenous Fungal Endophthalmitis: Fungal Isolates, Treatment Strategies and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):841. doi: https://doi.org/.
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To report the fungal isolates, treatment strategies and clinical outcomes of patients with exogenous fungal endophthalmitis (EFE).
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.
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.
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.
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