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β-D-glucan in Intraocular Fluids for Fungal Endophthalmitis: A Meta-Analysis of Diagnostic Test Accuracy
Sayaka Goto1, Yuki Mizuki1,2, Nobuyuki Horita3
1Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Purpose:
Fungal endophthalmitis (FE) is a rare but severe intraocular infection that may cause irreversible vision loss. Because conventional cultures are slow and insensitive and serum β-D-glucan (BDG) has limited value for intraocular disease, we evaluated the diagnostic accuracy of BDG testing in aqueous humor (AH) and vitreous humor (VH) for FE.
Methods:
We searched PubMed, Web of Science, EMBASE, and the Cochrane Library for studies of intraocular BDG testing for FE. Pooled sensitivity and specificity were calculated using a random-effects model, and the area under the summary receiver operating characteristic (SROC) curve and diagnostic odds ratio were used to assess diagnostic performance. Study quality was evaluated with QUADAS-2. An exploratory post hoc subgroup analysis compared AH and VH when specimen-specific data were available.
Results:
Six studies were identified and included. The pooled sensitivity and specificity of intraocular BDG testing were 0.86 (95% CI: 0.77-0.92) and 0.85 (95% CI: 0.78-0.90), respectively. The area under the SROC curve was 0.913, indicating good diagnostic accuracy, and no heterogeneity was observed for either sensitivity or specificity (both I² = 0.0%). Methodological quality was moderate, mainly because of patient-selection bias. In an exploratory specimen-type subgroup, study-level estimates ranged as follows: AH sensitivity 0.82-0.86 and specificity 0.80-0.87; VH sensitivity 0.94-1.00 and specificity 0.82-0.96.
Conclusion:
Intraocular BDG shows high diagnostic accuracy for FE and may serve as a valuable adjunctive tool, particularly when conventional culture methods are inconclusive or delayed.
Insights
Intraocular β-D-glucan (BDG) testing demonstrates high accuracy for diagnosing fungal endophthalmitis (FE). This method offers a valuable alternative when traditional cultures are slow or ineffective for detecting this severe eye infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Medical Diagnostics
Background:
- Fungal endophthalmitis (FE) is a severe intraocular infection with a high risk of irreversible vision loss.
- Conventional culture methods for FE are often slow and lack sensitivity.
- Serum β-D-glucan (BDG) testing has limited utility for intraocular infections.
Purpose of the Study:
- To evaluate the diagnostic accuracy of intraocular BDG testing in aqueous humor (AH) and vitreous humor (VH) for fungal endophthalmitis.
- To compare the diagnostic performance of BDG testing in different intraocular specimens.
Main Methods:
- A systematic review and meta-analysis of studies investigating intraocular BDG testing for FE.
- Searched major databases including PubMed, Web of Science, EMBASE, and Cochrane Library.
- Calculated pooled sensitivity, specificity, and area under the summary receiver operating characteristic (SROC) curve using a random-effects model.
Main Results:
- Six studies were included in the meta-analysis.
- Intraocular BDG testing showed pooled sensitivity of 0.86 and specificity of 0.85, with an SROC area of 0.913, indicating good diagnostic accuracy.
- Exploratory analysis suggested higher sensitivity for VH (0.94-1.00) compared to AH (0.82-0.86).
Conclusions:
- Intraocular BDG testing is a highly accurate diagnostic tool for fungal endophthalmitis.
- BDG testing in AH and VH can serve as a valuable adjunctive method, especially when cultures are inconclusive or delayed.
- This approach can aid in timely diagnosis and management of FE to prevent vision loss.
