Exogenous Fungal Endophthalmitis: Microbiology and Clinical Outcomes

Charles C. Wykoff, Harry W. Flynn, Darlene Miller, Ingrid Scott, Eduardo C. Alfonso

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

Objective: To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis. Design: Retrospective, single institution, consecutive case series. Participants: All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis. Methods: Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis. Main Outcome Measures: Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results: Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions: This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe-associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish (US)
JournalOphthalmology
Volume115
Issue number9
DOIs
StatePublished - Jan 1 2008

Fingerprint

Endophthalmitis
Microbiology
Keratitis
Antifungal Agents
Fungi
Fusarium
Amphotericin B
Aspergillus
Visual Acuity
Intraocular Injections
Temazepam
Vitrectomy
Disclosure
Candida
Medical Records
Therapeutics
Yeasts
Outcome Assessment (Health Care)
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Wykoff, Charles C. ; Flynn, Harry W. ; Miller, Darlene ; Scott, Ingrid ; Alfonso, Eduardo C. / Exogenous Fungal Endophthalmitis : Microbiology and Clinical Outcomes. In: Ophthalmology. 2008 ; Vol. 115, No. 9.
@article{c2a9e5151b1d4a2eba567f454d700368,
title = "Exogenous Fungal Endophthalmitis: Microbiology and Clinical Outcomes",
abstract = "Objective: To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis. Design: Retrospective, single institution, consecutive case series. Participants: All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis. Methods: Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis. Main Outcome Measures: Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results: Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44{\%}) associated with fungal keratitis, 10 cases (24{\%}) occurring after penetrating ocular trauma, and 13 cases (32{\%}) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85{\%}), and Candida species (yeasts) accounted for 6 cases (15{\%}). Although most keratitis cases were caused by Fusarium (13 of 18; 72{\%}), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38{\%}). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73{\%}) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59{\%}) cases. At least 1 pars plana vitrectomy was performed in 25 (61{\%}) eyes, and 29 (71{\%}) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54{\%}) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24{\%}) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions: This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85{\%} of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe-associated patients having the poorest outcomes. Overall, 44{\%} of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.",
author = "Wykoff, {Charles C.} and Flynn, {Harry W.} and Darlene Miller and Ingrid Scott and Alfonso, {Eduardo C.}",
year = "2008",
month = "1",
day = "1",
doi = "10.1016/j.ophtha.2008.02.027",
language = "English (US)",
volume = "115",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "9",

}

Exogenous Fungal Endophthalmitis : Microbiology and Clinical Outcomes. / Wykoff, Charles C.; Flynn, Harry W.; Miller, Darlene; Scott, Ingrid; Alfonso, Eduardo C.

In: Ophthalmology, Vol. 115, No. 9, 01.01.2008.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Exogenous Fungal Endophthalmitis

T2 - Microbiology and Clinical Outcomes

AU - Wykoff, Charles C.

AU - Flynn, Harry W.

AU - Miller, Darlene

AU - Scott, Ingrid

AU - Alfonso, Eduardo C.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Objective: To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis. Design: Retrospective, single institution, consecutive case series. Participants: All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis. Methods: Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis. Main Outcome Measures: Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results: Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions: This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe-associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

AB - Objective: To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis. Design: Retrospective, single institution, consecutive case series. Participants: All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis. Methods: Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis. Main Outcome Measures: Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results: Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions: This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe-associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

UR - http://www.scopus.com/inward/record.url?scp=50249149681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=50249149681&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2008.02.027

DO - 10.1016/j.ophtha.2008.02.027

M3 - Article

C2 - 18486220

AN - SCOPUS:50249149681

VL - 115

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 9

ER -