Open AccessUnderstanding the science of fungal endophthalmitis - AIOS 2021 Sengamedu Srinivas Badrinath Endowment Lecture
Author(s) -
Taraprasad Das,
Joveeta Joseph,
Saumya Jakati,
Savitri Sharma,
Thirumurthy Velpandian,
Srikant Kumar Padhy,
Vipin A Das,
Sisinthy Shivaji,
Sameera Nayak,
Umesh Chandra Behera,
Dilip Kumar Mishra,
Jaishree Gandhi,
Vivek Pravin Dave,
Avinash Pathengay
Publication year - 2022
Publication title -
indian journal of ophthalmology/indian journal of ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 51
eISSN - 1998-3689
pISSN - 0301-4738
DOI - 10.4103/ijo.ijo_2329_21
Subject(s) - medicine , endophthalmitis , evisceration (ophthalmology) , vitrectomy , blinding , antifungal , intensive care medicine , voriconazole , natamycin , clinical trial , randomized controlled trial , surgery , dermatology , visual acuity , pathology , alternative medicine
Fungal endophthalmitis is a potentially blinding condition. It is more often reported from Asia, including India. The incidence is lower than bacterial endophthalmitis. But it is relatively more challenging to treat than bacterial endophthalmitis. Many eyes may need therapeutic keratoplasty and/or evisceration. The current mainstays of treatment are vitrectomy irrespective of the presenting vision, intravitreal antifungal agents, and systemic therapy; additionally, the patients could require prolonged treatment with repeat vitreous surgeries and intravitreal injections. Difficulty in clinical diagnosis, delay in microbiological culture, and limited options of antifungal drugs make the treatment more difficult and less rewarding. Three common fungi causing endophthalmitis are Aspergillus, Fusarium, and Candida. The former two are molds, often identified in exogenous endophthalmitis, postoperative and traumatic; the latter is yeast and is more often identified in endogenous endophthalmitis. A faster diagnosis with newer molecular microbiological technologies might help institute treatment earlier than it is currently possible. A target trial using big data from different regions of the world might emulate a randomized clinical trial to design a definite treatment strategy. Given fewer antifungal drugs, one must be mindful of antifungal stewardship to prevent resistance to the existing drugs.