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Polymerase chain reaction for early diagnosis of post-operative fungal endophthalmitis
Bansidhar Tarai1, A Gupta, P Ray
1Department of Medical Microbiology , Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background And Objectives:
Fungal endophthalmitis is a devastating form of ocular infection and postoperative endophthalmitis following cataract surgery is the commonest form of such infection. Early diagnosis is very important for effective management of these patients. As conventional techniques take longer time and lacks sensitivity, polymerase chain reaction (PCR) for detection of fungal DNA was evaluated for early diagnosis of postoperative fungal endophthalmitis.
Methods:
Fifty consecutive patients with postoperative endophthalmitis (excluding proven bacterial endophthalmitis) and 25 individuals undergoing pars plana vitrectomy (PPV) of non infectious aetiologies (control group) were included in the study. Aqueous/vitreous fluids, collected from these patients, were evaluated by conventional methods including direct microscopy and culture, and by PCR for detection of fungal DNA using panfungal primers (ITS1 and ITS4) for diagnosis of fungal aetiology.
Results:
None of the controls were positive for fungal aetiology by microscopy, culture or PCR. Four patients were positive for fungal endophthalmitis by conventional method of diagnosis. PCR based method detected fungal DNA in three of these patients and in three additional patients who were negative on microscopy and culture. All six patients, who were positive for PCR, showed clinical improvement after full course of antifungal therapy.
Interpretation And Conclusion:
Compared to the conventional technique, PCR for detection of fungal DNA was found to be a rapid and more sensitive method in the early diagnosis of postoperative fungal endophthalmitis.
Insights
Polymerase chain reaction (PCR) offers a faster and more sensitive method for diagnosing fungal endophthalmitis after cataract surgery. This early detection aids in timely treatment and improved patient outcomes for this severe ocular infection.
Area of Science:
- Ophthalmology
- Medical Microbiology
- Molecular Diagnostics
Background:
- Fungal endophthalmitis is a severe ocular infection, often occurring post-cataract surgery.
- Conventional diagnostic methods for fungal endophthalmitis lack speed and sensitivity.
- Early diagnosis is crucial for effective management and preventing vision loss.
Purpose of the Study:
- To evaluate the efficacy of polymerase chain reaction (PCR) for the early diagnosis of postoperative fungal endophthalmitis.
- To compare the sensitivity and speed of PCR with conventional diagnostic techniques.
Main Methods:
- A study included 50 patients with postoperative endophthalmitis and 25 controls.
- Aqueous/vitreous fluid samples were analyzed using microscopy, culture, and PCR with panfungal primers.
- PCR targeted fungal DNA using ITS1 and ITS4 primers.
Main Results:
- No controls tested positive for fungal etiology.
- Conventional methods identified 4 cases of fungal endophthalmitis.
- PCR detected fungal DNA in all 4 conventional-positive cases and 3 additional cases, yielding 6 positive results overall.
- All PCR-positive patients showed clinical improvement with antifungal therapy.
Conclusions:
- PCR is a rapid and more sensitive diagnostic tool for postoperative fungal endophthalmitis compared to conventional methods.
- The enhanced sensitivity of PCR allows for earlier identification of fungal infections.
- This facilitates prompt initiation of antifungal treatment, leading to better patient outcomes.
