Endogenous Fungal Endophthalmitis and Pars Plana Vitrectomy (PPV)
Šišková A., Říhová E., Jandusová J., Dotřelová D., Mášová I.*
Oční klinika VFN a 1. LF UK, Praha, přednosta doc. MUDr. M. Filipec, CSc. *Mikrobiologická laboratoř, Cotraxim s.r.o. Praha |
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Summary:
Purpose: To report clinical findings, diagnostic and treatment possibilities of
patients with endogenous fungal endophthalmitis (EFE).
Methods: Retrospective study of 13 patients (19 eyes) with EFE diagnosed and
treated in the Dept. of Ophthalmology, 1st Medical Faculty, Charles University in
Prague. A detailed personal medical history was taken in all patients. Standard
ophthalmic examinations were performed in all cases.
Results: All of our patients had one or more of known risk factors for ocular fungal
infections. There were intravenous drug users, immunosuppressed patients, postoperative
patients receiving broad-spectrum antibiotics in our investigated
group. The mean age of the patients was 39 years (from19 to 68 years), the interval
between the first ocularsymptomsandcorrect diagnosiswasupto 7months (mean
2.1 months). Pars plana vitrectomy (PPV) was performed in 15 eyes and Amphotericin
B was instilled into vitreous cavity at the end of the procedure. Amphotericin
B was injected into vitreous without PPV in two eyes. All patients were
treated with systemic antifungal agents. Only Candida albicans was the cause of
EFE in 10 patients. Microscopic examination and culture were positive in 9
patients, 1 patient had positive serum antibodies against Candida albicans in significant titres. Final visual acuity improved in 47 % of the eyes, stabilized in
36 % of the eyes, and decreased in 17 % of the eyes.
Conclusion: Endogenous fungal endophthalmitis was seen as an opportunistic
disease in all patients. Candida albicans was the only evidenced cause of fungal
endophthalmitis. If prompt antifungal treatment after clinical suspicion of EFE
begins, successful visual outcome is possible.
Key words:
fungal endophthalmitis, Candida albicans, opportunistic disease,
antifungal drugs
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