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

Evaluations of visual acuity outcomes of eyes with endogenous fungal endophthalmitis were made retrospectively, according to the classification proposed by Ishibashi.

We surveyed endogenous fungal endophthalmitis cases at the 4 Nihon University Hospitals and 20 affiliated hospitals. Sixty eyes of 34 patients were classified into five stages according to Ishibashi's system, and therapeutic methods and visual outcomes in each stage were then evaluated.

Systemic antifungal drugs were efficacious in 82% of stage II and 69% of stage IIIa cases. Antifungal drugs were even efficacious in 42% of stage IIIb cases. Among the unresponsive cases, only half had been given the maximal dosage of antifungal drugs. Half of the eyes in which vitrectomy had been performed at stage IIIb 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 maximal dosage to stage II and IIIa cases. If these eyes progress to stage IIIb despite receiving the maximal dosage, vitrectomy is indicated. For stage IIIb eyes, the maximal dosage should be administered first. If not efficacious, vitrectomy should be carried out before progression to stage IV.