Post-traumatic fungal endophthalmitis-a prospective study

• Published in: Eye (London) Vol. 22; no. 1; pp. 13 - 17
• Main Authors: Gupta, A, Srinivasan, R, Kaliaperumal, S, Saha, I
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2008; Nature Publishing Group
• Subjects: Adolescent; Adult; Aged; Amphotericin B - administration & dosage; Antifungal Agents - administration & dosage; Aspergillus fumigatus; Biological and medical sciences; clinical-study; Endophthalmitis - drug therapy; Endophthalmitis - microbiology; Eye Infections, Fungal - drug therapy; Eye Infections, Fungal - microbiology; Eye Injuries, Penetrating - complications; Female; Fusarium solani; Humans; Laboratory Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Miconazole - administration & dosage; Microbial Sensitivity Tests; Middle Aged; Miscellaneous; Ophthalmology; Paecilomyces lilacinus; Pharmaceutical Sciences/Technology; Prospective Studies; Surgery; Surgical Oncology; open globe injury; fungal endophthalmitis; amphotericin sensitivity; intravitreal miconazole; minimum inhibitory concentration; Imidazole derivatives; Vitreous body; Uvea disease; Concentration; Trauma; Prospective; Antiprotozoal agent; Eye disease; Antibiotic; Antifungal agent; Sensitivity; Amphotericin B; Polyenic compound; Parasiticide; Lesion; Ophthalmology; Miconazole; Endophtalmitis
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/sj.eye.6702463

Purpose
To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.
Methods
This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.
Results
Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%.
Aspergillus
sp. and
Fusarium
sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 
μ
g/ml for all organisms except for
Paecilomyces lilacinus
and
Fusarium solani
, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.
Conclusions
Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal.
Aspergillus fumigatus
was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except
P. lilacinus
, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.