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Published on: February 6, 2021
Postoperative mycotic endophthalmitis
Florian Rensch1, Frank C Schlichtenbrede, Jost B Jonas
1Department of Ophthalmology, Medical Faculty Mannheim of Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
Unlabelled:
We report a series of 4 patients who experienced a low-grade mycotic endophthalmitis 3 to 7 months after uneventful cataract surgery. In all patients, the capsular bag was irrigated several times and amphotericin B was instilled intraocularly as well as systemically. In the fourth patient, a pars plans vitrectomy was been performed. Microbiological examination of aqueous humor samples revealed Candida parapsilosis in 3 patients and Candida albicans in 1 patient as causative microorganisms. At follow-up examinations performed up to 12 months after the lavage, visual acuities were 0.2, 0.1, 0.1, and hand motion in the 4 patients, respectively. The main reason for the remaining reduction in visual acuity was retinal and optic nerve atrophy. The findings show that a mycotic etiology of postoperative low-grade infectious endophthalmitis should be considered.
Financial Disclosure:
No author has a financial or proprietary interest in any material or method mentioned.
Insights
Post-cataract surgery low-grade mycotic endophthalmitis caused by Candida species can occur months later. Early treatment with antifungal agents is crucial, though visual outcomes may be impacted by retinal and optic nerve atrophy.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Cataract surgery is a common procedure with a low risk of infection.
- Postoperative endophthalmitis can manifest in various forms, including low-grade mycotic infections.
Observation:
- A series of four patients developed low-grade mycotic endophthalmitis 3-7 months after uneventful cataract surgery.
- Causative agents identified were Candida parapsilosis (3 patients) and Candida albicans (1 patient).
- Treatment involved intraocular and systemic amphotericin B, with one patient undergoing pars plana vitrectomy.
Findings:
- Visual acuities at 12 months post-treatment ranged from 0.2 to hand motion.
- Significant visual acuity reduction was primarily attributed to retinal and optic nerve atrophy.
- Mycotic etiology should be considered in delayed-onset, low-grade postoperative endophthalmitis.
Implications:
- Highlights the importance of considering fungal infections in persistent or delayed postoperative endophthalmitis.
- Emphasizes the need for prompt microbiological diagnosis and targeted antifungal therapy.
- Suggests potential long-term visual morbidity despite treatment, necessitating ongoing patient monitoring.
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