Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics

• DOI: 10.1016/j.oret.2023.11.004
• Publication Date: 2023-11-19T15:30:47Z
• Authors: Jae Hui Kim; Mihyun Choi; Seong-Woo Kim; Kyu Hyung Park; Dong Heun Nam; Dae Yeong Lee; Young-Hoon Park; Young-Gun Park; Mirinae Kim; Mee Yon Lee; Soon-Il Choi; Min Kim; Junwon Lee; Sang Woong Moon; Hyewon Chung; Young Hoon Lee; Min Woo Lee; Jae Pil Shin; Dong Ho Park; Han Sang Park; Yong Koo Kang; In Young Chung; Woong-Sun Yoo; Yong-Wun Cho; Yu Cheol Kim; Kyung Tae Kang; Ji Hye Jang; Seong-Woo Kim; Kwang-Eon Choi; Mihyun Choi; Ki Tae Nam; Young Ho Kim; So Min Ahn; Sang Joon Lee; Jae Wan Lim; Hee Chan Ku; Su Jin Yoo; Moon Jung Choi; Young Ju Lew; Jae Hui Kim; Joo Yeon Kim; Jae Hyung Hwang; Seung Woo Lee; Kunho Bae; Woo Jin Jeong; Yoon Hyung Kwon; Seoung Hyun An; Jeeyun Ahn; Joo Young Shin; Ik Soo Byon; Sung Who Park; Kyu Hyung Park; Se Woong Kang; Don-Il Ham; Sang Jin Kim; Un Chul Park; Baek Lok Oh; June-Gone Kim; Joo Yong Lee; Jun Yeop Lee; Yoon Jeon Kim; Ju Byung Chae; Dong Yoon Kim; Christopher Seung...; Kwan Hyuk Cho; Min Seok Kim; Seong Wook Kim; Jung Pil Lee; Hoon Dong Kim; In Hwan Cho; Ji Hun Song; Ki Hwang Lee; Han Jo Kwon; Seung Min Lee; Min Sagong; Tae Gon Lee; Jung Il Han; Young Suk Chang; Jung Kee Min; Yun Sik Yang; Soo Han Kim; Hee Seung Chin; Yong Sok Ji; Jong Young Lee; Seong Taeck Kim; Min Ho Shin; Jee Taek Kim; Yong Seop Han; Woo Hyuk Lee; Young Joon Jo; Jung Yeul Kim; Kyung Tae Kim; Eoi Jong Seo; Sun Taek Lim; Jun Sung Lee; Chang Ryong Kim; Daniel Duck-Jin H...; Ha Kyoung Kim; Dae Joong Ma; In Hwan Hong; Bum Joo Cho; Yong Un Shin; Heeyoon Cho; Seong Joon Ahn

To investigate the factors associated with treatment outcomes of post-cataract surgery fungal endophthalmitis outbreaks related to contaminated viscoelastics.Retrospective analysis of clinical data from multiple institutions.This study included 228 eyes of 210 patients who were diagnosed with post-cataract surgery fungal endophthalmitis related to the use of viscoelastic material (Unial®, Unimed Pharmaceutical Inc., Korea); they were followed up for 6 months after the diagnosis.Clinical features and causative species were identified and treatment outcomes were analyzed in patients who underwent 6 months of follow-up. Propensity score matching was conducted to elucidate the impact of vitrectomy timing and intraocular lens (IOL) removal on treatment outcomes.Clinical factors and selection of treatment modalities associated with treatment outcomes at 6 months.Baseline visual acuity (p < 0.01), age (p = 0.05), and the presence of corneal edema (p < 0.01) were closely associated with poor best-corrected visual acuity (BCVA) at 6 months. Patients who underwent immediate vitrectomy after diagnosis showed significantly better BCVA at 6 months (mean logarithm of minimum angle of resolution 0.26 ± 0.43 vs. 0.52 ± 0.52, p = 0.03) and greater degree of visual improvement (mean -0.17 ± 0.37 improvement vs. 0.10 ± 0.57 deterioration, p = 0.03) than those who underwent deferred vitrectomy. Patients who underwent IOL removal during vitrectomy required lower number of intravitreal anti-fungal agent injections (mean 8.9 ± 9.1 vs. 16.7 ± 12.2, p < 0.01) and showed lower incidence of repeated vitrectomy (20% vs. 82%, p < 0.01) than in those without IOL removal.In post-cataract fungal endophthalmitis, prompt vitrectomy at the time of diagnosis resulted in better treatment outcomes, and IOL removal reduced the treatment burden. Prompt and aggressive surgical intervention should be considered for post-cataract fungal endophthalmitis.