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Fungal endophthalmitis: A 20‐year experience at a tertiary referral centre
Author(s) -
Bhullar Gursimrat K.,
Dawkins Rosie C. H.,
Paul Rodger A.,
Allen Penelope J.
Publication year - 2020
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/ceo.13820
Subject(s) - medicine , endophthalmitis , etiology , fluconazole , visual acuity , prospective cohort study , referral , surgery , pediatrics , dermatology , antifungal , family medicine
Importance Fungal endophthalmitis is an uncommon and serious intraocular infection, often with poor outcomes. This study examines the trend in this disease over 20 years, to inform clinician decision‐making and optimize patient outcomes. Background Due to infrequent presentation of fungal endophthalmitis, there is limited understanding to formulate a standardized approach to management. Design A prospective case series over the period January 1, 1999 to December 31, 2018. Participants Patients with clinically diagnosed fungal endophthalmitis managed at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia. Methods Review of the Victorian Endophthalmitis Registry for endophthalmitis episode of each patient. Main outcome measures Patient demographics, co‐morbidities, visual acuity (VA) at presentation, aetiology, treatment, microbiology results and final VA outcome. Results Eighty‐four cases of fungal endophthalmitis were identified over the study period with a median age of 43.5 years [IQR 30.8‐63.0]. Then, 65.5% (n = 55) of patients were male; 81.0% (n = 68) of these cases were secondary to endogenous causes, of which 55.9% were associated with intravenous drug use (IVDU). Among the exogenous causes, penetrating eye injury (56.3%) was the most common aetiological factor. Thirty‐nine patients (46.4%) grew Candida species from ocular fluid specimens, all of which were sensitive to fluconazole. Conclusion and relevance Our case series provides important insights into fungal endophthalmitis—a high degree of suspicion for fungal endophthalmitis in patients with history of IVDU, and relatively good outlook for vision when Candida is the causative organism. This should allow institutions to implement a standardized management strategy based on evidence.