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Published on: February 6, 2021
Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis
Ella H Leung1, Ajay E Kuriyan1, Harry W Flynn1
1Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
Purpose:
To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis.
Design:
Retrospective consecutive case series.
Methods:
Setting: Tertiary referral center.
Patient Population:
Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015.
Interventions:
Intravitreal antifungal injection, pars plana vitrectomy (PPV).
Main Outcome Measure:
Clinical settings, microbiologic isolates, BCVA.
Results:
The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P = .83). The 9 patients (56%) who had intraocular lens (IOL) and capsular bag removals had better final BCVAs than those who did not (P = .011). The BCVAs were similar in eyes with yeast and mold (P = .37). The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16).
Conclusions:
Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.
Insights
Persistently culture-positive fungal endophthalmitis, often caused by molds, is linked to poor visual outcomes. Surgical removal of intraocular lenses and capsular bags improved vision in patients treated with pars plana vitrectomy and antifungal therapy.
Area of Science:
- Ophthalmology
- Infectious Diseases
Background:
- Exogenous fungal endophthalmitis is a severe intraocular infection.
- Persistent positive cultures indicate a challenging clinical course.
Purpose of the Study:
- To detail the clinical settings, causative fungal species, and visual outcomes in patients with persistent culture-positive exogenous fungal endophthalmitis.
- To identify factors influencing visual acuity in these cases.
Main Methods:
- Retrospective case series of 16 patients with consecutive positive vitreous cultures.
- Data collected on clinical presentation, microbiological findings, and best-corrected visual acuity (BCVA).
- Interventions included intravitreal antifungal injections and pars plana vitrectomy (PPV).
Main Results:
- Common settings included post-cataract surgery (56%) and glaucoma surgery (25%).
- Molds constituted 75% of isolates, though Candida was the most common single species (25%).
- Final BCVA was poor overall (mean 1.84 ± 1.2 logMAR), with 25% experiencing no light perception.
Conclusions:
- Molds are the predominant cause of persistently culture-positive fungal endophthalmitis.
- Pars plana vitrectomy (PPV) combined with intraocular lens (IOL) and capsular bag removal correlated with better visual outcomes.
- The condition is associated with a generally poor visual prognosis.
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