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Extreme Surgical Maneuvers in Fungal Endophthalmitis
María Isabel Relimpio-López1,2, María Gessa-Sorroche3, Antonio Manuel Garrido-Hermosilla1,2
1Retina Unit, Department of Ophthalmology, Virgen Macarena University Hospital, Seville, Spain.
Purpose:
To present the different evolution of 2 cases of endophthalmitis caused by Fusarium solani, an aggressive filamentous fungus, depending on the medical and surgical treatment performed.
Methods:
We present 2 cases of endophthalmitis caused by Fusarium solani. Topical, intrastromal, intravitreal, and systemic antifungal treatment (natamycin, voriconazole, amphotericin B) failed in both cases. Corneal perforation took place in one of them, being unsuccessfully treated with cyanoacrylate and several amniotic membrane transplants. It became necessary to perform a hot penetrating keratoplasty (PK) in both patients. The lenses were removed, and the microbiological analysis showed their colonization by Fusarium solani. In one of the cases, a second PK and a more aggressive pars plana vitrectomy (PPV) were performed after corneal recurrence detected by confocal microscopy, as well as the following therapeutic intra- and postoperative maneuvers: anterior chamber washing with povidone-iodine 5% for 1 min; iridectomy of the infiltrated regions; aspiration of the fungal colonies with vitrector; several air/fluid/amphotericin/voriconazole exchanges during PPV; endodiathermy and endophotocoagulation of the chorioretinitis foci; and intrascleral angle injections of voriconazole and amphotericin.
Results:
These were the only cases of endophthalmitis caused by Fusarium attended to at our hospital during the last 10 years. In the case in which PPV was performed without those maneuvers, endophthalmitis rapidly recurred in a more aggressive way, so finally it became necessary to eviscerate the globe. On the other hand, in the patient who underwent PPV with the specific surgical maneuvers and postoperative procedures described above, we could preserve the eye and even a vision of hand motion without an intraocular lens.
Conclusions:
The main objectives of these surgical procedures are to control the fungal infection and to preserve the ocular globe. It is essential to eliminate all ocular structures (iris, lens, vitreous, etc.) affected by this strain of fungus in order to reduce the risk of recurrence. When indicated, early surgery with the appropriate maneuvers detailed above may make an evisceration unnecessary and even recover some visual acuity.
Insights
Aggressive Fusarium solani fungal endophthalmitis requires extensive surgical intervention. Early, comprehensive surgical management, including pars plana vitrectomy with specific maneuvers, can prevent globe evisceration and preserve some vision.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fusarium solani is an aggressive filamentous fungus causing severe endophthalmitis.
- Standard antifungal treatments often fail in Fusarium solani endophthalmitis cases.
Purpose of the Study:
- To illustrate the varied clinical evolution of Fusarium solani endophthalmitis.
- To correlate treatment strategies with patient outcomes.
Main Methods:
- Two cases of Fusarium solani endophthalmitis are presented.
- Both cases failed medical and surgical treatments, necessitating penetrating keratoplasty (PK).
- One case underwent aggressive pars plana vitrectomy (PPV) with specialized intraoperative and postoperative antifungal maneuvers.
Main Results:
- The case without aggressive PPV maneuvers required globe evisceration due to recurrence.
- The case with comprehensive PPV and postoperative procedures preserved the globe and achieved hand motion vision without an intraocular lens.
- These represent the only Fusarium endophthalmitis cases at the institution in 10 years.
Conclusions:
- Aggressive surgical intervention is crucial for controlling Fusarium endophthalmitis.
- Eliminating all affected ocular structures minimizes recurrence risk.
- Early, tailored surgical approaches can prevent evisceration and potentially restore some vision.
