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L. I. Kump, E. Margalit; The Association of Candidemia and Ocular Candidiasis: Meta-Analysis of the Literature. Invest. Ophthalmol. Vis. Sci. 2008;49(13):941.
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To evaluate prevalence of fungal endophthalmitis and chorioretinitis in patients with candidemia using meta-analytical techniques.
Medline review covering January 1966 through March 2007 with the search terms "Candida or candidemia or candidiasis" and "endophthalmitis or chorioretinitis"was conducted. Analysis of all peer-reviewed articles of candidemia-associated fungal endophthalmitis and chorioretinitis published in the English language was performed.Inverse variance method was applied to the study.
Twenty two articles met the inclusion criteria. Ten studies were prospective and 12 retrospective. Seven studies were on adults and 15 on pediatric patients.Total number of patients was 1014; there were 64 patients with ocular candidiasis. Mean and confidence interval weighted by meta-analytic 1/v2 technique. A weighted mean prevalence of 1.78% was found with a 95% confidence interval of approximately 0.95% to 2.62%.
The linkage of candidal sepsis with candidal endophthalmitis /chorioretinitis suggested the use of ocular examinations to diagnose invasive candidiasis. Our analysis reveals that ocular involvement in candidemic patients is rare. It is attributed to prompt systemic antifungal therapy. In the reviewed literature the results of eye evaluations did not alter the course of antifungal therapy. Randomized prospective multi-center trial on patients with ocular candidiasis and candidemia could potentially elucidate the incidence of ocular involvement in fungal sepsis. Development and acceptance of universal guidelines are necessary for ocular evaluation of candidemic patients.
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