Outbreak of fungal endophthalmits following cataract surgery

Abstract

PurposeTo report clinical features, microbiology, and treatment outcomes of fungal endophthalmitis following cataract surgery.MethodsThe medical and cytopathologic records of all patients treated by the retina specialists at Nune Eye Hospital (Seoul, Korea) between May, 2014 and February, 2016 were retrospectively reviewed.ResultsTotal 13cases of 12 patients transfer to our hospital for management of endophthalmitis following cataract surgery at one local clinic between April 8, 2014 and May 15, 2014. A presenting best corrected visual acuity (BCVA) was various (range, hand motion – 20/40). Surgical managements include vitrectomy, capsulectomy, IOL removal and pre and postoperative intravitreal cocktail (vancomycin, ceftadizime with or without dexamethasone and voriconazole) injection were done. Fungal elements of were detected by direct microscopy in all patients. The final visual outcomes were as follows: 10 of 13 cases achieved ≥20/100 which same or better VA than at the first visit. However 3 of 13 cases resulted in poor VA because of enucleated due to uncontrolled inflammation and retinal detachment (RD), macular hole with RD and corneal ulcer in spite of good surgical outcome, respectively.ConclusionsFungal endophthalmitis following cataract surgery is rare but could occur. Therefore the possibility of fungal infection should always keep in mind when postoperative intraocular inflammation occurred. Also, fungal endophthalmitis could occur collectively. If fungal endophthalmitis is suspected or diagnosed, surgical management including IOL removal, total capsulectomy and exhaustive anterior vitrectomy should be performed as soon as possible and long term postoperative management including intravitreal injections and systemic treatment of antibacterial and antifungal agents may thought to be helpful in achieving a good visual outcome.