Severe fungal corneal ulcer resulting in infectious endophthalmitis

Abstract

To analyze causes of serious fungal corneal ulcer resulting in infectious endophthalmitis and explore clinical strategies of avoiding the failure of antifungal therapy. Etiological factors, pre-hospital treatments, clinical features and laboratory findings of 47 inpatients with fungal corneal ulcer resulting in endophthalmitis from January 1999 to December 2008 in Qingdao eye hospital were retrospectively reviewed. Rural residents (95.7%) dominated in 47 cases with a mean age of (49.8 ± 10.1) years. Ocular trauma was the leading cause of fungal corneal ulcer (66.0%). Three patients were ever treated with hormone drugs after the fungal infection. Primary, secondary and tertiary hospital accounted for 68.1%, 17.0% and 14.9% among first medical consultation sites. Diagnostic accuracies of fungal corneal ulcer in three grade hospitals were 31.3%, 62.5% and 71.4% respectively. The average interval from the onset of disease to the admission into our hospital was (29 ± 23) days. The dominating pathogen was genus Fusarium (91.5%) with F. solani (48.9%), F. oxysporum (31.9%) and F. moniliforme (8.5%). Antifungal drug sensitivity tests were performed in 21 patients. The first three sensitive drugs were natamycin (88.9%), voriconazole (78.6%) and amphotericin B (61.9%). The first three drug-resistant ones were miconazole (90.5%), fluconazole (66.7%) and itraconazole (61.9%). Main causes of fungal corneal ulcer resulting in infectious endophthalmitis included lower diagnostic accuracies of first medical consultation in primary hospitals, abuses of non-sensitive drug and delayed treatment of patients. Improving clinical capabilities of doctors in primary hospitals, emphasizing antifungal drug susceptibility tests, and consummating the social security system and the referral system could be effective measures to avoid therapeutic failures.