Abstract
Abstract: :
Purpose: To assess extraocular manifestations in patients for whom ocular findings led to the diagnosis of candida infection. A subset of patients was studied by optical coherence tomography (OCT). Methods: Consecutive cases seen between January 1996 and July 2003 in a single referral center were retrospectively analyzed. In patients with characteristic fundus lesions, the diagnosis was confirmed by Candida serology and/or identification of Candida by culture of vitreous fluid. Five patients were assessed by OCT. All patients were hospitalized in a single department of Internal Medicine, symptoms of systemic disease were recorded. Echocardiography, blood and urine culture were systematically performed. Results: Ten patients were included in the study (6 men, 4 women, mean age 36 years). Every patient reported that they were intravenous drug abusers. 2 patients had HIV infection and 6 had HVC infection. Ocular manifestations were unilateral, with painful red eyes, in all patients. The mean visual acuity at the initial visit was 20/710 ± 10,5 lines in Snellen units. Anterior uveitis was seen in all patients, with only one case of granulomatous presentation. The onset of focal inflammatory lesions was always in the posterior pole with involvement of the macula in 7 patients. OCT imaging showed highly reflective retinal lesions, protruding in the vitreous in all cases. A positive Candida serology was detected in 8/10 cases. All patients received fluconazole as initial treatment. In addition, a vitrectomy was performed in 5/10 patients, and candida was cultured in 4/5 cases. The mean final visual acuity was 20/130 ± 9.3 lines. Concomitant dermatologic manifestations of Candida infection were observed in 6/10 patients. Fever was never observed and the result of cardiologic examination was normal in all patients. Candida were never detected by blood and urine culture. Conclusion: Although the presumed mode of infection was hematogenous, eye and dermatologic manifestations were the only signs of candidosis in all cases. OCT imaging could be useful to evaluate macular involvement and to determine the time of vitrectomy.
Keywords: endophthalmitis • fungal disease • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)