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Acute fungal post-cataract endophthalmitis in the endophthalmitis management study: EMS report 7
Taraprasad Das1, Akash Belenje2, Joveeta Joseph3
1Anant Bajaj Retina Institute, Srimati Kanuri Santhamma centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India tpdbei@gmail.com.
Aim:
Investigate and characterise acute post-cataract fungal endophthalmitis pooled from the Endophthalmitis Management Study occurring within 6 weeks of primary surgery.
Methods:
The fungal infection was confirmed through conventional and molecular microbiology work-ups and antifungal susceptibility testing. Clinical examination included measurement of distant vision and intraocular pressure, anterior segment photo documentation and inflammation score (IS) measurement. Per the microbiology report, the eyes were divided into culture-positive (C+), sequencing-positive (S+) and sequencing-positive-unidentified (U+) fungi. Clinical correlations and statistical comparisons were performed between these three cohorts.
Results:
The study identified 21 patients with fungal endophthalmitis; it was 9.5% (21 of 220) of all acute post-cataract endophthalmitis in this study. Per the microbiology report, C+, S+ and U+ were 6, 9 and 6 patients, respectively. Fusarium and Aspergillus spp were the common fungi. The C+ fungi had higher presenting IS (p=0.023), shorter time to symptoms, worse presenting vision, corneal abscess (p=0.030) and higher probability of repeat intervention (p=0.042) than the other two groups. In the C+ group, the final vision of >20/400 was less (p=0.046) and phthisis bulbi was higher (p=0.010). All culturable fungi were resistant to amphotericin B and voriconazole.
Conclusion:
There is a 10% probability of acute post-cataract fungal endophthalmitis in India. The eyes presenting with corneal abscesses carry a higher risk. The polymicrobial infections shown in this cohort should be interpreted cautiously since next-generation sequencing detects DNA from all organisms, including residual or low-abundance or non-viable organisms that traditional culture might miss. Despite this, the new molecular microbiology technology is necessary to confirm diagnosis and expedite appropriate treatment. Given multi-antifungal agent resistance, routine susceptibility testing must be considered.
Insights
Acute post-cataract fungal endophthalmitis affects nearly 10% of patients in India, with corneal abscesses indicating higher risk. Fungal infections show resistance to common antifungals, necessitating susceptibility testing.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Cataract surgery is a common procedure, but complications like endophthalmitis can occur.
- Fungal endophthalmitis is a severe intraocular infection that can lead to vision loss.
- Early diagnosis and appropriate treatment are crucial for managing post-cataract endophthalmitis.
Purpose of the Study:
- To investigate and characterize acute post-cataract fungal endophthalmitis.
- To compare clinical outcomes based on microbiological diagnostic methods (culture vs. sequencing).
- To assess antifungal resistance patterns in fungal endophthalmitis.
Main Methods:
- Retrospective analysis of patients with acute post-cataract fungal endophthalmitis from the Endophthalmitis Management Study.
- Confirmation of fungal infection using conventional and molecular microbiology.
- Clinical assessment including visual acuity, intraocular pressure, and inflammation scoring.
- Antifungal susceptibility testing.
Main Results:
- Fungal endophthalmitis occurred in 9.5% of acute post-cataract endophthalmitis cases.
- Culture-positive cases showed higher inflammation, worse vision, and increased need for intervention.
- Common fungi included *Fusarium* and *Aspergillus* spp., with significant antifungal resistance observed.
Conclusions:
- Acute post-cataract fungal endophthalmitis has a significant incidence in India, particularly in cases with corneal abscesses.
- Molecular methods aid diagnosis but require careful interpretation due to detection of non-viable organisms.
- Multi-antifungal resistance highlights the need for routine susceptibility testing.
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