[Prognosis of endogenous fungal endophthalmitis and utility of Ishibashi's classification]

Prognostic evaluations of eyes with endogenous fungal endophthalmitis were made according to the classification proposed by Ishibashi.

We surveyed endogenous fungal endophthalmitis cases at four Nihon University Hospitals and 20 branch hospitals. Sixty eyes of 34 patients were classified into five stages according to Ishibashi's proposal, and therapeutic methods and visual prognosis in each stage were then evaluated.

Systemic antifungal drugs were efficacious in 82% of stage II and 69% of stage IIIa cases. Even among stage III b cases, antifungal drugs were efficacious in 42%. Among the unresponsive cases, only half had been given the maximum dosage of antifungal drugs. Half of the eyes in which vitrectomy was performed at stage III b achieved a postoperative visual acuity of 0.5 or better and none had a visual acuity of less than 0.03.

Based on the above results, we concluded that systemic antifungal drugs should be administered at the maximum dosage in stage II and III a cases. If these eyes progress to stage III b despite the maximum dosage, vitrectomy is indicated. For stage III b eyes, the maximum dosage should be administered first. If the maximum dosage is not efficacious, vitrectomy should be carried out before progression to stage IV.