May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Exogenous Fungal Endophthalmitis: Fungal Isolates, Treatment Strategies and Visual Outcomes
Author Affiliations & Notes
  • C. C. Wykoff
    Ophthalmology, Bascom Palmer Eye Institite, Miami, Florida
  • H. W. Flynn, Jr.
    Ophthalmology, Bascom Palmer Eye Institite, Miami, Florida
  • D. Miller
    Ophthalmology, Bascom Palmer Eye Institite, Miami, Florida
  • I. U. Scott
    Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
  • E. C. Alfonso
    Ophthalmology, Bascom Palmer Eye Institite, Miami, Florida
  • Footnotes
    Commercial Relationships  C.C. Wykoff, None; H.W. Flynn, None; D. Miller, None; I.U. Scott, None; E.C. Alfonso, None.
  • Footnotes
    Support  Supported by the National Institute of Health center grant P30-EY014801 and an unrestricted grant to the University of Miami from Research to Prevent Blindness.
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 841. doi:https://doi.org/
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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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      © ARVO (1962-2015); The Authors (2016-present)

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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 
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