[Mycotic endophthalmitis: management and treatment (9 year study)]

Fungal endophthalmitis: management and therapy (a 9 years experience).

The development of new azoles with a better ocular bioavailability (fluconazole), and the improvement of vitrectomy has recently influenced the treatment of fungal endophthalmitis.

Records of patients treated for fungal endophthalmitis at the Jules Gonin Eye Hospital were retrospectively reviewed from January 1992 to December 2000. Initial and final visual acuities, risk factors, treatment outcomes and side effects were evaluated. Data were examined separately according to the therapy.

17 patients (13 males, 4 females, mean age 54 years - 27 eyes) were enrolled. 14/27 eyes were treated by oral fluconazole only (group I) for a mean duration of 5.8 +/- 3.4 months. In this series the mean initial visual acuity was 0.73 +/- 0.4 (Snellen chart), the mean final visual acuity was 0.91 +/- 0.3 in 12 eyes, hand motion and light perception in 2 eyes. 10/27 eyes (group II) with severe vitritis and/or retinal detachment underwent pars plana vitrectomy, intraocular injection of amphotericin B, and short course of oral fluconazole. The initial mean visual acuity was 0.36 +/- 0.3 in 8 eyes, hand motion in 2 eyes; the final mean visual acuity was 0.46 +/- 0.4 in 9 eyes. Vitrectomy was repeated in 3 eyes, 1 of which was subsequently enucleated due to painful phthisis. 2 patients (3 eyes) did not receive any treatment.

Oral fluconazol is successful in the management of mild fungal endophthalimitis. In more severe cases, additional vitrectomy and intraocular amphotericin B injection should be considered. In such cases, pars plana vitrectomy is thought to be effective in removing the majority of the fungal charge and in allowing a direct supply of antifungal agents to the retinal infectious foci.