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Implications of early systemic therapy on the incidence of endogenous fungal endophthalmitis
1The W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, USA.
Objective:
In the past, evidence of endogenous fungal endophthalmitis has been used as a guide to initiating potentially toxic antifungal therapy in patients with systemic fungal infections. Recently, however, a trend has developed to provide patients with antifungal therapy at the first evidence of fungal infection. The authors' study evaluates the incidence of endogenous fungal endophthalmitis in this setting.
Design:
The design is a retrospective review of the medical records of patients examined by the inpatient ophthalmology consultation service to rule out endogenous fungal endophthalmitis between January 1994 and April 1996 at the University of Michigan Hospitals, Ann Arbor, Michigan.
Participants:
Two hundred fourteen eyes of 107 patients with a diagnosis of systemic fungal infection were studied.
Intervention:
A review of medical records was performed.
Main Outcome Measures:
The findings of the ocular examination, the presence of risk factors for disseminated fungal infection, the type of antifungal therapy, and the source and identity of the isolated fungus were recorded.
Results:
The majority of patients examined had either fungal growth from blood cultures or evidence of deep tissue fungal infection. All patients in the study were at risk for fungal disease with each having at least one risk factor for disseminated fungal infection. Of the patients examined, 93.4% already were receiving systemic antifungal therapy at the time of ophthalmologic consultation. Only 3 (2.8%) of the 107 patients examined had chorioretinal findings consistent with early endogenous fungal endophthalmitis. None had intravitreous involvement, and the ocular findings did not change the course of therapy.
Conclusions:
Early systemic treatment of deep tissue fungal infection appears to dramatically decrease the incidence of endogenous fungal endophthalmitis.
Insights
Early systemic antifungal therapy significantly reduces the incidence of endogenous fungal endophthalmitis in patients with systemic fungal infections. This proactive approach appears to prevent severe ocular complications.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Endogenous fungal endophthalmitis diagnosis historically guided antifungal therapy initiation.
- A recent trend involves initiating antifungal therapy upon initial evidence of fungal infection.
- This study investigates the incidence of endogenous fungal endophthalmitis under this new treatment paradigm.
Purpose of the Study:
- To evaluate the incidence of endogenous fungal endophthalmitis in patients receiving early systemic antifungal therapy for systemic fungal infections.
- To assess the impact of proactive antifungal treatment on the development of ocular fungal infections.
Main Methods:
- Retrospective review of medical records of 107 patients (214 eyes) with systemic fungal infections.
- Ophthalmology consultation service data from January 1994 to April 1996 at University of Michigan Hospitals.
- Recorded ocular examination findings, risk factors, antifungal therapy details, and fungal isolates.
Main Results:
- 93.4% of patients were already on systemic antifungal therapy at ophthalmologic consultation.
- Only 2.8% of patients exhibited chorioretinal findings consistent with early endogenous fungal endophthalmitis.
- No patients had intravitreous involvement, and ocular findings did not alter existing therapy.
Conclusions:
- Early systemic treatment of deep-tissue fungal infections appears to significantly decrease the incidence of endogenous fungal endophthalmitis.
- Proactive antifungal therapy may prevent the progression to severe ocular fungal disease.