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Fungal endophthalmitis: prompt vitrectomy & intravitreal injection of antifungals has best outcome

August 11 2015

The incidence of fungal endophthalmitis is increasing. It is a serious condition which can cause loss of eyesight, and the visual prognosis of fungal endophthalmitis is poor.  Patients with endogenous endophthalmitis generally have other underlying debilitating diseases such as malignancy, organ transplantation, candidaemia, or other immunocompromised status; but those with exogenous fungal infections are usually immunocompetent.

A study was undertaken by Kim et al in Korea, primarily to establish the causative organisms but also to assess differences in visual prognosis between endogenous and exogenous endophthalmitis; to assess treatment methods and differences in visual prognosis and any systemic risk factors.

A total of 40 eyes from 30 patients with fungal endophthalmitis were included in this study. Endogenous and exogenous endophthalmitis were observed in a total of 33 and 7 eyes respectively. Candida species were the most common causative organisms in 35 of 40 eyes. Of those, 25 were identified as Candida albicans, 6 were identified as C. tropicalis and 4 were other sub-species of Candida. Only one or two cases were caused by Fusarium, Scedosporium or Acremonium. The 40 eyes were treated using the following modalities: intravitreal antifungal agent injection with intravenous antifungal agent (16 eyes), vitrectomy with intravenous antifungal agent (14 eyes), intravenous antifungal agent alone (9 eyes), and evisceration (1 eye).

 It was concluded that  if the general condition of the patient tolerates a surgical procedure, prompt vitrectomy along with intravitreal injection of antifungal improved visual acuity when compared to other methods.

Article: Kim D Y et al, Korean Med Sci 2015; 30: 960-964

Images: copyright of D W Denning.