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Outcomes and Clinical Features Predictive of Fungal Endophthalmitis

Aaron Z Priluck1, Peng Huang2, Mark P Breazzano3

  • 1From the Wilmer Eye Institute, Johns Hopkins Hospital; Johns Hopkins University School of Medicine (A.Z.P., M.P.B.), Baltimore, Maryland.

American Journal of Ophthalmology
|February 23, 2023
PubMed
Abstract

Insights

Certain risk factors increase fungal endophthalmitis likelihood after intravitreal antifungal injections. Presenting visual acuity is a key prognostic factor, and current screening guidelines appear valid as no fungal endophthalmitis cases were asymptomatic.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Medical Research

Background:

  • Intravitreal antifungal injections are used to treat fungal eye infections.
  • Distinguishing fungal endophthalmitis from similar conditions is crucial for appropriate management.
  • Risk factors and prognostic indicators for fungal endophthalmitis require further elucidation.

Purpose of the Study:

  • To identify risk factors associated with fungal endophthalmitis at presentation.
  • To determine prognostic factors influencing visual outcomes in patients receiving intravitreal antifungal injections.
  • To evaluate the effectiveness of American Academy of Ophthalmology (Academy) screening guidelines for Candida septicemia (candidemia).

Main Methods:

  • A retrospective case-control study was conducted at a single tertiary center.
  • Data from 75 patients (81 eyes) treated with intravitreal antifungal injections between 2014 and 2021 were analyzed.
  • Clinical features, visual outcomes, and final diagnoses were compared between fungal endophthalmitis and masquerade syndromes.

Main Results:

  • Factors significantly increasing fungal endophthalmitis likelihood included emergency department/inpatient injection, presence of an artificial indwelling line, recent sepsis, and specific comorbidities like complicated diabetes mellitus and actively treated cancer.
  • Presenting visual acuity was a strong predictor of final visual outcome (R² = 0.3524, P < .0001).
  • No patients diagnosed with fungal endophthalmitis were asymptomatic or identified through screening protocols.

Conclusions:

  • Specific patient and treatment-related factors can indicate a higher risk of fungal endophthalmitis.
  • Presenting visual acuity is a critical prognostic factor for visual recovery.
  • The findings support the current Academy candidemia screening guidelines, as no fungal endophthalmitis cases were detected via screening.

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