Fungal Endophthalmitis

• DOI: 10.1016/j.oret.2021.09.006
• Publication Date: 2021-09-20T05:21:30Z
• Authors: Taraprasad Das; Manisha Agarwal; Appakkudal R. Anand; Umesh C. Behera; Muna Bhende; Anthony Vipin Das; Debarati Dasgupta; Vivek P. Dave; Jaishree Gandhi; Rameshkumar Gunas...; Joveeta Joseph; Sucheta Kulkarni; Prajna Lalitha; Priyanka A. Mahen...; Sanchita Mitra; Ashik Mohamed; Alankrita Muralidhar; Pillutla L. Nimes...; Gumpalli S. Prash...; Alok Sen; Savitri Sharma; Prithviraj Uday
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 16. Peace & justice; 3. Good health

Abstract Purpose To evaluate the clinical and microbiological features of a large cohort of culture-confirmed fungal endophthalmitis across India. Design Cross-sectional hospital-based retrospective medical records review. Participants Seven large tertiary eye care centers from different regions of India. Methods The patient data were pooled from the electronic/physical medical records of each participating center. Fellowship-trained vitreoretinal specialists clinically managed all patients, and in-house microbiology laboratories performed all microbiology work-ups. The clinical and microbiology procedures were broadly uniform across all participating centers. The essential treatment consisted of vitreous surgery and intravitreal and systemic therapy with antifungal agents. Main Outcome Measures Clinical outcome by the causative event and causative fungus. Results In the 2005-2020 period, seven centers treated 3830 cases of culture-proven endophthalmitis, and 19.1% (n=730) were culture-confirmed fungal endophthalmitis. It included 46.9% postoperative (87.4% post-cataract surgery), 35.6% traumatic and 17.5% endogenous endophthalmitis. The fungi included 39.0% Aspergillus (high in central, east and south zones), 15.1% Candida (high in west zone), 15.9% Fusarium (high in north and west zone). The time to symptoms was between 1w-4w in more than a third of patients except in traumatic endophthalmitis. Less than half of patients had hypopyon on presentation. Presenting visual acuity (PVA) in most patients was 20/400 in 30.5% (n= 222) eyes; > 20/40 in 7.9% (n=58) eyes; and 12% (n=88) eyes lost light perception. Post-hoc analysis showed significantly more males in traumatic than post-operative (p Conclusions Fungal endophthalmitis is not uncommon in India. The inclusion of antifungal agents with antibiotics as the first empirical intravitreal therapy before microbiological confirmation could be considered when fungal infection is suspected,