Postoperative Fungal Endophthalmitis Research Articles

Wickerhamomyces Anomalus Postoperative Endophthalmitis

ABSTRACT Introduction We describe the case of a postoperative fungal endophthalmitis caused by Wickerhamomyces anomalus, an opportunistic yeast common in nature but rare as a causative agent in ocular infections. This would be the second reported case of W. anomalus endophthalmitis. Case report A patient came to our hospital with a dense hemovitreous caused by an inadvertent ocular perforation and retinal detachment during a cataract surgery. In the days following the first vitreoretinal surgery a chronic postoperative endophthalmitis was evidenced. Only after several surgeries as well as intravitreal antibiotics and sample takings, Wickerhamomyces was detected. The treatment with oral voriconazole and an intraocular lens extraction controlled the infection. Discussion Wickerhamomyces anomalus, despite not being particularly aggressive in our case, was resistant to various consequent vitreoretinal surgeries. The unresponsiveness to treatment led us to contemplate the fungal etiology, and fortunately the cultures were positive for this yeast. In conjunction to antifungal therapy, it is possible that the IOL explantation played an important role in the treatment. Conclusion A high index of suspicion must be held in cases of fungal endophthalmitis. Both IOL explantation and oral antifungal therapy are useful treatment options in cases of W. anomalus endophthalmitis.

Decisive role of histopathology of lens capsule in the diagnosis of chronic fungal postoperative endophthalmitis

We report three cases of refractory chronic endophthalmitis after cataract surgery presenting to a referral center, and with repeated negative cultures. Initial treatment consisted of intravitreal and systemic antibiotics, with partial improvement. After subsequent worsening, pars plana vitrectomy, intraocular lens explantation and en bloc capsulectomy were performed. Histopathological examination revealed multiple filamentous fungal structures, sequestered between anterior/posterior lens capsule in all cases. Chronic postoperative fungal endophthalmitis may manifest with negative cultures possibly associated with sequestration of the microorganism into the capsular bag. Careful histopathological examination of lens capsule in these cases may be essential for a definite diagnosis.

Management of postoperative fungal endophthalmitis with section infiltrates: Our experience

Aim: The aim of the study is to report the management of postoperative fungal endophthalmitis (POFE with corneoscleral infiltrates) after the cataract surgery. Settings and Design: The study was conducted at a tertiary care referral center in North Andhra. This was a retrospective, single-institution, interventional case series. Materials and Methods: Ten cases were microbiologically proven POFE, out of which eight cases having sclera-corneal infiltrates and two cases having corneal infiltrates, refractory to conventional management, were included in this study. Four cases were managed with intraocular lens (IOL) explantation, pars plana vitrectomy (PPV), intravitreal vancomycin, ceftazidime, and voriconazole, followed by the excision of corneoscleral infiltrate and therapeutic patch graft/therapeutic penetrating keratoplasty (TPK) as a secondary procedure. Six cases were managed with IOL explantation, excision of infected corneoscleral tissue, therapeutic corneoscleral patch graft/TPK, and anterior vitrectomy with intravitreal voriconazole. “Anatomical success” was defined as preserved anatomy of the globe and absence of signs of inflammation. “Functional success” was defined as an attached retina and a best-corrected visual acuity of better than 20/400. Results: Of the ten cases, the duration between cataract surgery and the diagnosis of endophthalmitis was 2–10 weeks in nine cases and 3 days in one case. Five cases were culture and potassium hydroxide (KOH) positive for fungus (Aspergillus fumigatus – 3, Aspergillus flavus – 1, and Aspergillus niger – 1), and five cases were KOH positive for fungus. No recurrences were observed after corneal patch graft/TPK with PPV and IOL explantation (Median follow-up – 12 months). Prestudy defined the criteria for successful “anatomical” and “functional” outcomes were achieved in 90% and 50%, respectively. Conclusion: This report highlights the effective role of combined IOL explantation, excision of infected tissue, therapeutic patch graft with PPV, and intravitreal voriconazole in managing POFE with corneoscleral infiltrates.

Postoperative fungal endophthalmitis due to Basidiobolus ranarum: Report of a rare case

Postoperative fungal endophthalmitis is a significant cause of visual loss due to the rapid progress and severe inflammation. Management is dictated by the precise identification of fungus subspecies, choice of antifungal agent, and associated systemic features. We report a rare case caused by Basidiobolusranarum, never known to have caused endophthalmitis or any form of ocular infection or inflammation. A 59-year-old, Asian, immunocompetent, agriculturist presented with endophthalmitis on the 3 rd postoperative day. Smear and culture from the aqueous and vitreous samples detected a species of fungus called Basidiobolusranarum. Fungal endophthalmitis should be suspected even in patients who present in the early postoperative period and rare species considered even in immunocompetent individuals. Early detection and aggressive treatment is necessary for preventing morbidity or mortality due to these infections.

Management of recurrent postoperative fungal endophthalmitis

Aim:To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.Settings and Design:Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.Materials and Methods:Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ‘Anatomical success’ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ‘Functional success’ was defined as an attached retina and a best corrected visual acuity of better than 20/400.Results:Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re – PPV (median follow-up, 37 months). Pre-study defined criteria for successful ‘anatomical’ and ‘functional’ outcomes were achieved in 83.3% and 50% respectively.Conclusion:This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.

Chronic postoperative fungal endophthalmitis caused by trichosporon asahii.

To describe a patient with chronic postoperative fungal endophthalmitis caused by Trichosporon asahii. A retrospective case report. An 82-year-old woman was found to have culture-proven T. asahii chronic fungal endophthalmitis with initial symptoms beginning 18 months after uneventful phacoemulsification with intraocular lens implantation. Successful treatment was achieved with pars plana vitrectomy, capsulectomy, and oral voriconazole without explantation of the intraocular lens. This is the first reported case of chronic postoperative T. asahii endophthalmitis. Our patient was successfully treated with pars plana vitrectomy, capsulectomy, and oral voriconazole without explantation of the intraocular lens.

Use of Voriconazole in the Surgical Management of Chronic Postoperative Fungal Endophthalmitis

Management of postoperative mycotic endophthalmitis remains challenging. This study reports successful management of postoperative chronic fungal endophthalmitis with vitrectomy surgery and voriconazole. A retrospective interventional case series of four eyes of four patients with chronic fungal endophthalmitis treated with pars plana vitrectomy and oral and intravitreal voriconazole is described. Pars plana vitrectomy, en bloc capsulectomy, and explantation of the intraocular lens were then performed combined with one to four intravitreal injections of voriconazole and oral voriconazole for up to 5 weeks. Identified fungal species included Aspergillus, Acremonium, Penicillium, and Verticillium. Voriconazole may have affected the clinical and surgical management of fungal endophthalmitis.

Results of Extensive Surgical Treatment of Seven Consecutive Cases of Postoperative Fungal Endophthalmitis

PurposePostoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity.MethodsThe present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections.ResultsRetinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart.ConclusionsEarly extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.

Successful Treatment of Postoperative Fungal Endophthalmitis Using Intravitreal and Intracameral Voriconazole

The aim of this study was to describe 3 cases of postoperative fungal endophthalmitis successfully treated with anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection. Three (3) patients from a single retina center in India developed culture-proven fungal endophthalmitis after cataract surgery in 1 eye. All patients underwent anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injections intraoperatively. All cases demonstrated substantial improvement in vision and intraocular inflammation after surgery. The combination of anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection is a viable therapeutic option in cases of fungal endophthalmitis.

Treatment of two postoperative endophthalmitis cases due to Aspergillus flavus and Scopulariopsis spp. with local and systemic antifungal therapy

BackgroundEndophthalmitis is the inflammatory response to invasion of the eye with bacteria or fungi. The incidence of endophthalmitis after cataract surgery varies between 0.072–0.13 percent. Treatment of endophthalmitis with fungal etiology is difficult.Case PresentationCase 1: A 71-year old male diabetic patient developed postoperative endophthalmitis due to Aspergillus flavus. The patient was treated with topical amphotericin B ophthalmic solution, intravenous (IV) liposomal amphotericin-B and caspofungin following vitrectomy.Case 2: A 72-year old male cachectic patient developed postoperative endophthalmitis due to Scopulariopsis spp. The patient was treated with topical and IV voriconazole and caspofungin.ConclusionAspergillus spp. are responsible of postoperative fungal endophthalmitis. Endophthalmitis caused by Scopulariopsis spp. is a very rare condition. The two cases were successfully treated with local and systemic antifungal therapy.

Fungi from the Normal Outer Eye

With the recognition of mycotic keratitis as a major ocular disease, there has been in­ creasing interest in the fungi associated with the healthy eye. Studies from diverse geo­ graphical areas indicate that fungi occur in none to 28% of normal outer eyes. These data are usually based on single culturings of a varying number of conjunctival sacs. The organisms isolated represent a broad spec­ trum of molds and yeastlike fungi, some of which, such as Aspergillus and Candida spp., have been isolated from keratomycoses. It has been suggested that a native fungal flora may represent the source of infection in my­ cotic keratitis and postoperative fungal endophthalmitis. The existence of an indigenous bacteria flora of the normal outer eye, composed mainly of micrococci and diptheroids, has been established by repetitive cultures by nu­ merous investigators. Unequivocable evi­ dence for an indigenous fungal flora of the normal eye has not been established. This study was undertaken to ascertain the inci­ dence and persistence of fungi in the envi­ rons of the normal outer eye.