June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Guarded Hope: Clinical Presentation, Outcomes, and Practice Patterns of Endogenous Fungal Endophthalmitis
Author Affiliations & Notes
  • ROHAN BAJAJ
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Marisa Tieger
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Yifan Lu
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Sandra Hoyek
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Nimesh A. Patel
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   ROHAN BAJAJ None; Marisa Tieger None; Yifan Lu None; Sandra Hoyek None; Nimesh Patel Alimera Sciences, Code C (Consultant/Contractor), Alcon, Code C (Consultant/Contractor), Allergan, Code C (Consultant/Contractor), Genentech, Code C (Consultant/Contractor)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 695 – F0220. doi:
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      ROHAN BAJAJ, Marisa Tieger, Yifan Lu, Sandra Hoyek, Nimesh A. Patel; Guarded Hope: Clinical Presentation, Outcomes, and Practice Patterns of Endogenous Fungal Endophthalmitis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):695 – F0220.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Endogenous fungal endophthalmitis is a rare entity without a consensus approach to management. The aim of the study is to provide data on the presentation and practice patterns to guide future clinical decision making.

Methods : A retrospective chart review was performed on a cohort with established endogenous fungal endophthalmitis between 2009-2021 at Massachusetts Eye and Ear. Linear regression was performed to analyze the correlation between days to pars plana vitrectomy (PPV) and improvement in visual acuity. Wilcoxon Signed-Rank tests were used to compare VA improvement between initial presentation vs. final visit, early (within 3 days) vs. late (after 3 days) PPV, IV vs. topical antifungals, and intravitreal voriconazole vs. amphotericin.

Results : Fourteen eyes from 13 patients (92.8% male) with a median age of 43.5 years (IQR: 23-79) were included. The initial median VA was 1.676 LogMAR (IQR: 0.301-2.477). Initial slit lamp exam most often revealed vitritis (93.0%), AC flare (86.0%), hypopyon (50.0%), and keratic precipitates (50.0%). It took an average of 1.54 days (Median 0; IQR 0-7) to establish a diagnosis of endogenous fungal endophthalmitis. Cultures were obtained via vitreous (78.6%) or anterior chamber (21.4%) aspirates. Within an average of 7.38 days (IQR: 1-38 days), most cultures (85.7%) grew candida species (albicans, dubliniensis, tropicalis, and glabrata). Most patients received intravitreal (85.7%) and IV (73.3%) antifungals. Two patients (14.3%) received PPV within 1 day of presentation as their initial intervention. 78.5% of the cohort received a PPV within an average of 11.3 days (Median 10, IQR: 1-38). There was a statistically significant improvement in the final median VA, 0.544 LogMAR (IQR: 0-2.477) (Z=2.8241, p<0.005). No eyes had to be enucleated or eviscerated. There were no statistically significant differences (p>0.05) in VA outcomes with early vs. late PPV, IV vs. topical antifungals, or between intravitreal voriconazole vs. amphotericin. There was no statistically significant correlation (p>0.05) between the days to PPV and final VA improvement.

Conclusions : The most common causative species to cause endogenous fungal endophthalmitis was Candida. Surgical intervention with PPV was often required to achieve an improvement in visual acuity and outcomes were generally favorable.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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