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Pseudozyma aphidis endophthalmitis post-cataract operation: Case discussion and management
Shong Min Voon1, Arlo Upton2, Deepak Gupta1
1Department of Ophthalmology, Dunedin Public Hospital, 201 Great King Street, Dunedin, 9016, Otago, New Zealand.
Purpose:
To present a case of fungal endophthalmitis with a novel organism and our management.
Observations:
A 46 year old male presented with delayed-onset acute endophthalmitis 6 weeks after routine phacoemulsification and intraocular lens implantation. Initial treatment with intravitreal antibiotics did not improve his condition. With repeated vitreal taps, the causative organism was eventually identified as a fungus, Pseudozyma aphidis. Treatment with oral and intravitreal voriconazole, as well as pars plana vitrectomy, led to resolution of the endophthalmitis and recovery of vision to 20/25.
Conclusions And Importance:
Fungal endophthalmitis is a rare, potentially blinding complication of cataract surgery. We report our approach to this previously unreported organism, that led to an excellent visual outcome. There are no specific guidelines for fungal endophthalmitis. The management approach has to be tailored to the clinical response and emerging laboratory data from the microbiologist. Identification of the organism will require specialist laboratory references that may not be available in all hospitals. Ophthalmologists must work closely with microbiologists in order to ensure an optimal outcome.
Insights
A rare fungal endophthalmitis case caused by Pseudozyma aphidis after cataract surgery was successfully treated. Prompt diagnosis and tailored management, including voriconazole and surgery, restored vision.
Area of Science:
- Ophthalmology
- Mycology
- Infectious Diseases
Background:
- Fungal endophthalmitis is a rare but serious complication following cataract surgery.
- Delayed-onset endophthalmitis requires thorough etiological investigation.
Observation:
- A 46-year-old male developed delayed-onset endophthalmitis six weeks post-cataract surgery.
- Initial antibiotic treatment failed; subsequent investigations revealed Pseudozyma aphidis as the causative agent.
Findings:
- Combined oral and intravitreal voriconazole therapy, alongside pars plana vitrectomy, effectively resolved the fungal endophthalmitis.
- Visual acuity improved to 20/25 following treatment.
Implications:
- This case highlights Pseudozyma aphidis as a novel cause of fungal endophthalmitis.
- Management requires a personalized approach based on clinical response and microbiological data.
- Collaboration between ophthalmologists and microbiologists is crucial for optimal outcomes in rare fungal infections.
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