Korean J Ophthalmol.  2009 Sep;23(3):159-163. 10.3341/kjo.2009.23.3.159.

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

• Yang YS

• KMID: 1115746
• DOI: http://doi.org/10.3341/kjo.2009.23.3.159

Abstract

PURPOSE
Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity. METHODS: The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections. RESULTS: Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart. CONCLUSIONS: Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.

Keyword

Cataract; Endophthalmitis; Fungal; Postoperative; Vitrectomy

MeSH Terms

Aged
Aged, 80 and over
Antifungal Agents/therapeutic use
Blindness/etiology
*Candidiasis/drug therapy
Device Removal
Endophthalmitis/complications/*microbiology/*surgery
Female
Humans
Laser Coagulation
Lens Capsule, Crystalline/surgery
Lenses, Intraocular
Male
Middle Aged
*Postoperative Complications
Retrospective Studies
Treatment Outcome
*Vitrectomy

Figure

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  Fig. 1 Preoperative findings of the anterior segment showed whitish inflammatory material around the intraocular lens (Left), and vitreous opacity and inflammatory materials throughout the entire vitreous (Right).

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  Fig. 2 Following vitrectomy in case 6, bullous retinal detachment and vitreous inflammatory materials were seen on ocular ultrasound (Left). Fluorescent leaking surrounding the disc appeared on fluorescein angiography in case 7 (Right).

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