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A. Sallam, A. Khan, P. McCluskey, W. A. Lynn, N. Okhravi, K. Manku, S. Lightman; Visual Outcome and Prognostic Predictors of Endogenous Fungal Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):955. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcome of endogenous fungal endophthalmitis in 2 tertiary care centres.
Patients in this study were identified from the endophthalmitis data base between February 1992 and August 2002. Thirty two patients (41 eyes) had clinical evidence of endogenous fungal endophthalmitis, 21 (65.6%) males and 11 females, with a mean age of 42.5 years. Diagnosis of endogenous fungal endophthalmitis was based on typical clinical findings and/or a positive intraocular culture, in a patient with risk factors such as intravenous drug abuse, immunosuppression or following surgical procedures. Five eyes (12%), however, had no obvious risk factor.
The presenting visual acuity was ≤ 6/60 in 26 (63.4%) eyes. Fungi were detected in the vitreous or other peripheral sites as blood and urine in 15 eyes. Eight of 22 vitreous taps and 4 of 17 (23.5%) vitrectomy samples were culture positive. Two (2/41) eyes did not have any intraocular sampling. In 4 eyes (3 patients), fungi were isolated from peripheral sites only. Candida albicans was the most common fungi cultured. All Candida spp. isolated were sensitive to fluconazole and amphotericin B. Aspergillus spp. were sensitive to itraconazole and econazole but resistant to amphotericin B, with no recording of fluconazole sensitivity.Thirty-three (80.5%) eyes received intravitreal amphotericin B. Systemic antifungal therapy was used in the management of 31/41 (75.6%) eyes with 56.1% of eyes treated with oral fluconazole.Twenty-six (63.4%) eyes had presenting visual acuity of ≤6/60. Two patients died after presentation, one had bilateral involvement. Nineteen [(19/38 (50%)] eyes achieved a final visual acuity of ≥6/12 and 25 (65.8%) achieved an acuity of ≥6/60. Seventy three percent (11/15) of eyes presenting with a visual acuity of ≥6/36 achieved a final acuity of ≥6/12 compared to 34.8% (8/23) of eyes presenting with ≤6/60 vision (Fischer’s exact, p=0.045). Comparing eyes managed with vitrectomy to those managed without, 10/17 eyes (58.8%) vs. 9/21 (42.9%), respectively achieved a final acuity of ≥6/12 (chi-square, p=0.328). Culture positivity/negativity did not seem to affect the visual outcome.
Overall, 50% of patients achieved a final visual acuity of ≥6/12 and 65% achieved acuity of ≥6/60. Eyes presenting with good visual acuity tend to have better visual outcome.
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