Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis

Abstract Purpose To report the clinical settings, microbiological isolates, and best corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis. Design Retrospective, consecutive, case series. Methods Setting: Tertiary referral center. Patient po...

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Bibliographic Details
Published in:	American journal of ophthalmology 2016-12, Vol.172, p.45-50
Main Authors:	Leung, Ella H, Kuriyan, Ajay E, Flynn, Harry W, Relhan, Nidhi, Huang, Laura C, Miller, Darlene
Format:	Article
Language:	eng
Subjects:	Aged Antifungal Agents - therapeutic use Candida Cataracts Endophthalmitis - diagnosis Endophthalmitis - drug therapy Endophthalmitis - microbiology Eye Infections, Fungal - diagnosis Eye Infections, Fungal - microbiology Eye surgery Female Follow-Up Studies Funding Fungi - isolation & purification Glaucoma Humans Injections Male Ophthalmology Patients Retrospective Studies Studies Testing laboratories Vitrectomy Vitreous Body - diagnostic imaging Vitreous Body - microbiology
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Summary:	Abstract Purpose To report the clinical settings, microbiological isolates, and best corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis. Design Retrospective, consecutive, case series. Methods Setting: Tertiary referral center. Patient population: 16 eyes of 16 patients with at least two consecutive positive vitreous cultures between 1981-2015. Interventions: Intravitreal antifungal injections, pars plana vitrectomy (PPV) Main Outcome Measure: Clinical settings, microbiologic isolates, BCVA Results The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P =0.83). The 9 patients (56%) who had IOL and capsular bag removals had better final BCVAs than those who did not ( P =0.011). The BCVAs were similar in eyes with yeast and mold ( P =0.37).The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16). Conclusions Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.
ISSN:	0002-9394 1879-1891