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Karina Esquenazi, Carl Stanley Wilkins, Rupak Bhuyan, Jonathan Levenson, Robin N Ginsburg, Alexander Barash, Avnish Deobhakta, Gareth M.C. Lema; Evaluation of prevalence and risk factors for vitreoretinal involvement in fungemic patients at a tertiary care hospital. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1353.
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The prevalence of endogenous fungal endophthalmitis varies between studies and the risk factors are poorly defined. This study aims to define prevalence in a large population and identify risk factors warranting ophthalmic evaluation.
Retrospective review of 291 inpatients with fungemia and a documented ophthalmic evaluation (January 2015-September 2019) was performed. We reviewed the presence of visual complaint, number and duration of positive blood cultures, history of gastrointestinal (GI) surgery in preceding 6 months, solid organ transplant, human immunodeficiency virus (HIV) infection, diabetes mellitus (DM), intravenous (IV) drug use, and central venous access. Student’s t-test and chi-squared statistical analysis were performed.
291 patients were included; 6 had vitreoretinal involvement and 2 required intravitreal antifungal injection. Those with vitreoretinal involvement had an average of 3 positive cultures over 0.69 weeks, while those with normal findings averaged 2.85 positive cultures over 0.59 weeks (p= 0.89, and 0.80, respectively). History of GI surgery, organ transplant, immunocompromised state, DM, IV drug use, and central venous catheter were not found to be significant. However, 33.3% of the endophthalmitis group had a visual complaint compared to 4.20% of the non-endophthalmitis group (p<0.001). When grouped together, visual complaints, positive blood cultures for 3 or more days, and history of recent GI surgery were significant predictors of ocular involvement. For patients without any of these 3 major risk factors, the negative predictive value was 98.7%.
Patients who have visual complaints at the time of positive fungal blood culture are significantly more likely to have a positive screening examination. No other individual variables were found to be predictive of a positive screening examination. A positive examination is exceedingly rare in patients not meeting risk criteria (major factors) for screening. Serious consideration of replacing the current practice of uniform ophthalmic screening among fungemic patients with examination limited to those meeting major criteria is recommended.
This is a 2021 ARVO Annual Meeting abstract.
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