Endogenous Fungal Endophthalmitis and Pars Plana Vitrectomy (PPV)

Overview

Purpose:
To report clinical findings, diagnostic and treatment possibilities ofpatients with endogenous fungal endophthalmitis (EFE).Methods: Retrospective study of 13 patients (19 eyes) with EFE diagnosed andtreated in the Dept. of Ophthalmology, 1st Medical Faculty, Charles University inPrague. A detailed personal medical history was taken in all patients. Standardophthalmic examinations were performed in all cases.Results: All of our patients had one or more of known risk factors for ocular fungalinfections. There were intravenous drug users, immunosuppressed patients, postoperativepatients receiving broad-spectrum antibiotics in our investigatedgroup. The mean age of the patients was 39 years (from19 to 68 years), the intervalbetween the first ocularsymptomsandcorrect diagnosiswasupto 7months (mean2.1 months). Pars plana vitrectomy (PPV) was performed in 15 eyes and AmphotericinB was instilled into vitreous cavity at the end of the procedure. AmphotericinB was injected into vitreous without PPV in two eyes. All patients weretreated with systemic antifungal agents. Only Candida albicans was the cause ofEFE in 10 patients. Microscopic examination and culture were positive in 9patients, 1 patient had positive serum antibodies against Candida albicans in significant titres. Final visual acuity improved in 47 % of the eyes, stabilized in36 % of the eyes, and decreased in 17 % of the eyes.Conclusion: Endogenous fungal endophthalmitis was seen as an opportunisticdisease in all patients. Candida albicans was the only evidenced cause of fungalendophthalmitis. If prompt antifungal treatment after clinical suspicion of EFEbegins, successful visual outcome is possible.

Key words:
fungal endophthalmitis, Candida albicans, opportunistic disease,antifungal drugs