Relation between stage of endogenous fungal endophthalmitis and prognosis

Although many studies have been published on the risk factors and therapies for endogenous fungal endophthalmitis (EFE), only a few have been published on the relationship between the stage of EFE at the initial examination and the prognosis. Thus, the purpose of this study was to determine the relation between the stage of EFE at the initial examination and the prognosis.

A total of 103 eyes of 58 patients (40 men, 18 women) with EFE, examined over a 20-year period (1984-2004), were studied. The severity of the EFE at the initial examination was classified into four stages. In addition, the type of fungus, general status, initial and final visual acuity, findings of the anterior and posterior segments, latent fungal infection, duration from initial symptoms to initial visit, history of intravenous hyperalimentation (IVH), results of the Candida Detection System, and beta-D-glucan levels were analyzed.

More than 95% of the patients had some type of underlying disorder. Candida albicans was detected initially in the blood in 40 patients. The stage of the EFE advanced as the time from the initial symptoms to the beginning of therapy increased. The final visual acuity was significantly correlated with the stage of EFE at the initial examination. In 20 of 21 patients, blood beta-D-glucan was positive, and 42 patients (90%) were receiving IVH.

Because the stage of EFE advanced with the time between the initial symptoms and the beginning of therapy, and because of the high correlation between the stage of EFE and the final visual acuity, it is very important that treatment be begun as soon as possible. Thus, in patients with visual symptoms and susceptible to opportunistic infections, an early consultation with an ophthalmologist is highly recommended.