Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis

Thomas F. Essman, Harry W Flynn, William E Smiddy, Roy D. Brod, Timothy G. Murray, Janet L Davis, Patrick E. Rubsamen

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND OBJECTIVE: To review prevalence of organisms, associated factors, and treatment outcomes from one medical center's 10-year experience managing culture-proven endogenous fungal endophthalmitis (EFE). PATIENTS AND METHODS: The authors retrospectively reviewed the microbiology and corresponding clinical records of patients diagnosed as having culture- proven EFE at the Bascom Palmer Eye Institute during a 10-year period. RESULTS: Culture-proven EFE occurred in 20 eyes of 18 patients. Candida species occurred in 17 of 20 eyes (85%), and Aspergillus species occurred in 3 of 20 eyes (15%). The most common association was long-term intravenous line placement, which was present in 12 patients (67%). Whereas 12 patients (67%) had a history of recent hospitalization, only 2 (11%) had a documented history of systemic fungal infection. After initial examination, only 2 patients had a systemic culture positive for a fungal organism (none had a positive blood culture). Treatment after initial examination included pars plana vitrectomy in 17 of the 20 eyes (85%), intravitreal amphotericin B in 19 eyes (95%), and systemic antifungal medication in 16 eyes of 15 patients. Thirteen of the 17 eyes (76%) with Candida endophthalmitis and 0 of 3 eyes with Aspergillus endophthalmitis achieved visual acuity of 20/400 or better. CONCLUSION: The most common cause of culture-proven EFE at the authors' institution is Candida species. The overall visual outcomes were more favorable for Candida cases than they were for Aspergillus cases. In the treatment of patients with marked vitreous infiltrates from EFE, pars plana vitrectomy, intravitreal amphotericin B injection, and administration of appropriate systemic antifungal medication (fluconazole for Candida) are generally recommended.

Original languageEnglish
Pages (from-to)185-194
Number of pages10
JournalOphthalmic Surgery and Lasers
Volume28
Issue number3
StatePublished - Mar 1 1997

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Endophthalmitis
Candida
Aspergillus
Temazepam
Vitrectomy
Amphotericin B
Mycoses
Fluconazole
Microbiology
Visual Acuity
Hospitalization
Injections

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. / Essman, Thomas F.; Flynn, Harry W; Smiddy, William E; Brod, Roy D.; Murray, Timothy G.; Davis, Janet L; Rubsamen, Patrick E.

In: Ophthalmic Surgery and Lasers, Vol. 28, No. 3, 01.03.1997, p. 185-194.

Research output: Contribution to journalArticle

Essman, Thomas F. ; Flynn, Harry W ; Smiddy, William E ; Brod, Roy D. ; Murray, Timothy G. ; Davis, Janet L ; Rubsamen, Patrick E. / Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. In: Ophthalmic Surgery and Lasers. 1997 ; Vol. 28, No. 3. pp. 185-194.
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abstract = "BACKGROUND AND OBJECTIVE: To review prevalence of organisms, associated factors, and treatment outcomes from one medical center's 10-year experience managing culture-proven endogenous fungal endophthalmitis (EFE). PATIENTS AND METHODS: The authors retrospectively reviewed the microbiology and corresponding clinical records of patients diagnosed as having culture- proven EFE at the Bascom Palmer Eye Institute during a 10-year period. RESULTS: Culture-proven EFE occurred in 20 eyes of 18 patients. Candida species occurred in 17 of 20 eyes (85{\%}), and Aspergillus species occurred in 3 of 20 eyes (15{\%}). The most common association was long-term intravenous line placement, which was present in 12 patients (67{\%}). Whereas 12 patients (67{\%}) had a history of recent hospitalization, only 2 (11{\%}) had a documented history of systemic fungal infection. After initial examination, only 2 patients had a systemic culture positive for a fungal organism (none had a positive blood culture). Treatment after initial examination included pars plana vitrectomy in 17 of the 20 eyes (85{\%}), intravitreal amphotericin B in 19 eyes (95{\%}), and systemic antifungal medication in 16 eyes of 15 patients. Thirteen of the 17 eyes (76{\%}) with Candida endophthalmitis and 0 of 3 eyes with Aspergillus endophthalmitis achieved visual acuity of 20/400 or better. CONCLUSION: The most common cause of culture-proven EFE at the authors' institution is Candida species. The overall visual outcomes were more favorable for Candida cases than they were for Aspergillus cases. In the treatment of patients with marked vitreous infiltrates from EFE, pars plana vitrectomy, intravitreal amphotericin B injection, and administration of appropriate systemic antifungal medication (fluconazole for Candida) are generally recommended.",
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