ROLE OF EARLY VITRECTOMY IN THE TREATMENT OF FUNGAL ENDOPHTHALMITIS

Area of Science:

• Ophthalmology
• Infectious Diseases
• Surgical Outcomes

Background:

• Fungal endophthalmitis is a severe intraocular infection.
• Prompt diagnosis and treatment are crucial for preserving vision.
• The optimal timing for surgical intervention remains a key consideration.

Purpose of the Study:

• To evaluate the impact of immediate pars plana vitrectomy versus diagnostic vitrectomy alone on visual and structural outcomes in fungal endophthalmitis.
• To compare outcomes between early surgical intervention and delayed intervention based on microbiological confirmation.

Main Methods:

• A retrospective analysis of 66 patients with culture-positive fungal endophthalmitis.
• Patients were divided into two groups: immediate vitrectomy (Group 1) and diagnostic vitrectomy alone (Group 2).
• Demographics, clinical features, and visual/structural outcomes were compared between the groups.

Main Results:

• Demographics and clinical signs were comparable between the groups.
• While post-treatment vision was not significantly different, Group 1 showed significant visual improvement (P=0.0278).
• Early vitrectomy plus antifungals yielded statistically significant visual improvement over diagnostic vitrectomy plus antifungals (P=0.013).
• Phthisis rates were similar in both groups (25.8% vs. 25.7%).

Conclusions:

• Early vitrectomy combined with intravitreal antifungals, based on strong clinical suspicion, leads to favorable visual and structural outcomes in fungal endophthalmitis.
• Delaying antifungal therapy until microbiological confirmation may result in poorer outcomes.
• Prompt surgical intervention is recommended for suspected fungal endophthalmitis.