Original article
Endogenous Fungal Endophthalmitis: Causative Organisms, Management Strategies, and Visual Acuity Outcomes

https://doi.org/10.1016/j.ajo.2011.06.020Get rights and content

Purpose

To report the causative organisms, management strategies, and visual outcomes in endogenous fungal endophthalmitis.

Design

Observational case series.

Methods

Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous fungal endophthalmitis between January 1, 1990, and July 1, 2009.

Results

Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up.

Conclusions

Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous fungal endophthalmitis. Endogenous fungal endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.

Section snippets

Methods

Microbiologic and clinical records were reviewed from all patients treated at Bascom Palmer Eye Institute (BPEI) between January 1, 1990, and July 1, 2009, for intraocular culture-proven endogenous fungal endophthalmitis (n = 51). After obtaining a list of the causative organisms, the corresponding medical records were reviewed for clinical presentation, treatment strategy, and outcomes. Study inclusion criteria were positive fungal culture results and clinical course consistent with endogenous

Demographics

Study criteria were met in 51 patients (65 eyes). Of the 51 patients included in this study, 30 were men. The mean age was 51 years, with a range from 3 months to 92 years. Three patients were younger than 1 year of age. Follow-up ranged from 2 days to more than 15 years (median, 138 days). Fourteen patients had bilateral endogenous fungal endophthalmitis.

Time from onset of symptoms to presentation ranged from 0 to 60 days (mean, 13 days). No patients were identified through routine screening.

Discussion

The clinical features and presentation of endogenous fungal endophthalmitis have been reported previously in multiple case reports and small clinical case series.1, 2, 3, 10, 11, 12 Few reviews have focused solely on endogenous fungal endophthalmitis. In addition, not all previously reported cases have been both microbiologically and clinically confirmed. To our knowledge, this study is the largest series of culture-proven endogenous fungal endophthalmitis.

Retinal detachment is not an uncommon

Ahila Lingappan, MD, received her medical degree from Baylor College of Medicine in Houston, Texas. In 2010, she completed her ophthalmology residency at the Bascom Palmer Eye Institute in Miami, Florida. She is currently practicing general ophthalmology in Voorhees, New Jersey.

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Ahila Lingappan, MD, received her medical degree from Baylor College of Medicine in Houston, Texas. In 2010, she completed her ophthalmology residency at the Bascom Palmer Eye Institute in Miami, Florida. She is currently practicing general ophthalmology in Voorhees, New Jersey.

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