Endogenous fungal endophthalmitis: risk factors, clinical course, and visual outcome in 13 patients
Authors:   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel, Corredores Jamel , Jaouni Tareq ,   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel, Habot-Wilner Zohar ,   Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel, Kramer Michal ,   Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel; Division of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel, Shulman Shiri ,   Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel; Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel, Jabaly-Habib Haneen ,   Department of Ophthalmology, Poriya Medical Center, Tiberias 1528001, Israel, Al-Talbishi Ala'a ,   St John Eye Hospital, Jerusalem 91198, Israel, Halpert Michael ,   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel, Averbukh Edward ,   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel, Levy Jaime ,   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel, Deitch-Harel Iris ,   Sackler Faculty of Medicine, Tel Aviv University, Tel Avi 6997801, Israel; Division of Ophthalmology, Rabin Medical Center, Petah Tikva 49100, Israel, Amer Radgonde ,   Department of Ophthalmology, Hadassah Medical Center, Jerusalem 91240, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
Published: January 2021

AIM: To analyze the risk factors, ophthalmological features, treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis (EFE).
METHODS: Data retrieved from the medical files included age at presentation to the uveitis clinic, gender, ocular symptoms and their duration before presentation, history of fever, eye affected, anatomical diagnosis and laboratory evidence of fungal infection. Medical therapy recorded included systemic antifungal therapy and its duration, use of intravitreal antifungal agents and use of oral/intravitreal steroids. Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.
RESULTS: Included were 13 patients (20 eyes, mean age 58y). Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation. In one patient, there was no history of previous intervention. Diagnostic vitrectomy was performed in 16 eyes (80%) and vitreous cultures were positive in 10 of the vitrectomized eyes (62.5%). In only 4 patients (31%), blood cultures were positive. All patients received systemic antifungal therapy. Sixteen eyes (80%) received intravitreal antifungal agent with voriconazole being the most commonly used. Visual acuity (VA) improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last follow-up (P=0.03). A trend of greater visual improvement was noted in favor of eyes treated with oral steroids (±intravitreal dexamethasone) than eyes that were not treated with steroids. The most common complication was maculopathy. Twelve eyes (60%) showed no ocular complications.
CONCLUSION: High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation. Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention. Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.