Exogenous Fungal Endophthalmitis: Microbiology and Clinical Outcomes
Presented at: American Academy of Ophthalmology (AAO) 2007 Annual Meeting, November 10–13, 2007; New Orleans, Louisiana.
Received 5 October 2007; received in revised form 26 February 2008; accepted 27 February 2008. published online 16 May 2008.
Objective
To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis.
Design
Retrospective, single institution, consecutive case series.
Participants
All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis.
Methods
Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis.
Main Outcome Measures
Fungal isolates, treatment strategies, visual acuity, and rate of enucleation.
Results
Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients.
Conclusions
This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe–associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: July 14, 2008.
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
2Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
Correspondence: Charles C. Wykoff, MD, PhD, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136
Manuscript no. 2007-1309.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Supported by the National Institutes of Health, Bethesda, Maryland (grant no.: P30-EY014801), and an unrestricted grant to the University of Miami from Research to Prevent Blindness, Inc., New York, New York.
ABSTRACT