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N. Umeda, H. Ozaki, K. Murata, A. Yamaguchi, E. Uchio; Delayed-Onset Endophthalmitis Caused by Fusarium After Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):684.
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We described a patient with refractory Fusarium endophthalmitis after cataract surgery.
Interventional case report. The diagnosis and treatment of the one case was reviewed.
A 71-years- old man who had a history of urogenital cancers presented with visual loss and eye pain in his left eye at 5 month after cataract surgery. Aqueous humor samples were taken for standard microbiological tests (culture and stains), however, all tests showed negative. Subsequently, inflammation increased in his left eye, despite treated with antibacterial and corticosteroid eyedrops. Eventually, vitrectomy and removal of intraocular lens was performed, and Fusarium was isolated from the removed lens capsule. The patient received 100 mg itraconazole thereafter. Three month after vitrectomy, the inflammation recurred and did not resolved despite systemic treatment with micafangin, itraconazole and voriconazole. Therefore, intraocular injection of amphotericin B (10 µg/0.1 ml) and voriconazole (100 µg/0.1 ml) were given topically to the patient's eye. Inflammation remained stationary, however visual disturbance remained due to the plaque formed behind the cornea. Vitrectomy with intraocular injection of voriconazole was performed for the second time. The fungus mass in the cornea significantly reduced, and visual acuity improved HM to 20/500 one month postoperatively.
We showed a case of endophthalmitis caused by Fusarium species after cataract surgery. Diagnosis of this rare complication, Fusarium fungal endophthalmitis, is difficult by aqueous sample, but possible upon culturing IOL and lens capsule. In refractory cases like this, vitrectomy with intraocular injection of voriconazole is effective.
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