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Jila Noori, George Trichonas, Joseph N Martel, Andrew W Eller; Analysis of Predisposing Factors and Management Course of Endogenous Fungal Endophthalmitis: A Five-Year Experience in a Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6386.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze risk factors, clinical features, management strategies and treatment outcomes in endogenous fungal endophthalmitis
Microbiological and medical records of all fungal endophthalmitis diagnosed from January 2010 through September 2015 at UPMC Eye Center were reviewed. The demographic data, social and medical history, fungus species, presenting and final visual acuity, clinical findings, and results of the treatment modalities were analyzed.
A total of 32 eyes from 28 patients were included, based on clinical disease or/and positive smears or cultures. Age range was 17-85 years with the average of 45.3 years. 16 patients were men. Four patients had bilateral involvement. Thirteen patients (46.4%) had a history of intravenous drug abuse. Other risk factors included fungemia caused by indwelling lines (17.8%), and immunosuppression (28.6%). 40.6% were culture positive with Candida species, with exception of one Aspergillus. Treatment modalities included: 1) systemic antifungal agent alone (7 eyes), 2) primary vitrectomy with oral antifungal agent (10 eyes), 3) intravitreal (IVT) antifungal agent injection with oral antifungal agent (15 eyes) followed by vitrectomy in 10 eyes. In the latter group, vitrectomy was performed in eyes without clinical resolution, 2 to 56 days after IVT with antifungal medication. Only three of 23 eyes with noticeable vitritis were controlled without vitrectomy. Retinal detachment occurred in 8 eyes (25%). Inflammatory response noted in 2 eyes after treatment was initiated (Jarisch-Herxheimer type reaction). Presenting visual acuity ranged from 20/20 to light perception, with 62.5% having a visual acuity of 20/200 or less at presentation. 40.6% of subjects overall achieved a final visual acuity of 20/100 or better.
In this series, IV drug abuse was the leading risk factor for endogenous fungal endophthalmitis. Only patients with chorioretinitis with or without minimal vitreous involvement were controlled with systemic or IVT antifungal therapy, alone. Two-thirds of eyes treated with initial antifungal IVT, later required a vitrectomy. Earlier vitrectomy may be a better choice for treatment in eyes with marked vitritis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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