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Post-traumatic fungal endophthalmitis--a prospective study.
A Gupta1, R Srinivasan, S Kaliaperumal
1Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. arvind_ophthal@yahoo.co.in
Eye (London, England)
|June 6, 2006
Summary
Fungal endophthalmitis after open globe injury is rare but has a poor visual outcome. Aspergillus fumigatus is the most virulent, with most fungi sensitive to amphotericin B or miconazole.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Fungal endophthalmitis is a severe complication following open globe injuries.
- Early diagnosis and treatment are crucial for visual preservation.
Purpose of the Study:
- To investigate the incidence and clinical presentation of fungal endophthalmitis post-open globe injury.
- To evaluate the efficacy of antifungal treatments in these cases.
Main Methods:
- Prospective study of 8 patients with fungal endophthalmitis out of 110 open globe injuries.
- Treatment included intravitreal amphotericin B, with miconazole added for inadequate response.
- Pars plana vitrectomy was performed in select cases.
Main Results:
- Aspergillus and Fusarium species were the most common isolates (62.5%).
- Intraocular specimen yield was high (vitreous 87.5%, aqueous 66.6%).
- 37.5% of patients achieved a final visual acuity of 20/400 or better.
Conclusions:
- Fungal endophthalmitis post-open globe injury has a dismal visual prognosis.
- Aspergillus fumigatus demonstrated high virulence.
- Antifungal sensitivity varied, with P. lilacinus requiring miconazole; repeated intravitreal injections may be necessary.