An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea
Authors: Kim Seong Woo , Kim Jae Hui , Choi Mihyun , Lee Sang Joon , Shin Jae Pil , Kim June Gone , Kang Se Woong , Park Kyu Hyung ,   Korean Retina Society members, Nam Dong Heun , Lee Dae Yeong , Park Young-Hoon , Park Young-Gun , Kim Mirinae , Choi Soon-Il , Kim Min , Lee Junwon , Moon Sang Woong , Chung Hyewon , Lee Young Hoon , Lee Min Woo , Shin Jae Pil , Park Dong Ho , Park Han Sang , Kang Yong Koo , Chung In Young , Yoo Woong-Sun , Cho Yong-Wun , Kim Yu Cheol , Kang Kyung Tae , Jang Ji Hye , Kim Seong-Woo , Choi Kwang-Eon , Choi Mihyun , Nam Ki Tae , Kim Young Ho , Ahn So Min , Lee Sang Joon , Lim Jae Wan , Ku Hee Chan , Yoo Su Jin , Choi Moon Jung , Lew Young Ju , Kim Jae Hui , Kim Joo Yeon , Hwang Jae Hyung , Lee Seung Woo , Bae Kunho , Jeong Woo Jin , Kwon Yoon Hyung , An Seoung Hyun , Ahn Jeeyun , Shin Joo Young , Byon Ik Soo , Park Sung Who , Park Kyu Hyung , Kang Se Woong , Ham Don-Il , Kim Sang Jin , Park Un Chul , Oh Baek Lok , Kim June-Gone , Lee Joo Yong , Lee Jun Yeop , Kim Yoon Jeon , Chae Ju Byung , Kim Dong Yoon , Lee Christopher Seungkyu , Cho Kwan Hyuk , Kim Min Seok , Kim Seong Wook , Lee Jung Pil , Kim Hoon Dong , Cho In Hwan , Song Ji Hun , Lee Ki Hwang , Kwon Han Jo , Lee Seung Min , Sagong Min , Lee Tae Gon , Han Jung Il , Chang Young Suk , Min Jung Kee , Yang Yun Sik , Kim Soo Han , Chin Hee Seung , Ji Yong Sok , Lee Jong Young , Kim Seong Taeck , Shin Min Ho , Kim Jee Taek , Han Yong Seop , Lee Woo Hyuk , Jo Young Joon , Kim Jung Yeul , Kim Kyung Tae , Seo Eoi Jong , Lim Sun Taek , Lee Jun Sung , Kim Chang Ryong , Hwang Daniel Duck-Jin , Kim Ha Kyoung , Ma Dae Joong , Hong In Hwan , Cho Bum Joo , Shin Yong Un , Cho Heeyoon , Ahn Seong Joon 
Published: January 2023

ImportanceFungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis.ObjectiveTo report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea.Design, Setting, and ParticipantsThis was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022.Main Outcomes and MeasuresThe clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up.ResultsThe fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%).Conclusions and RelevanceThis was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.