MANAGEMENT OF POSTOPERATIVE ACREMONIUM-ENDOPHTHALMITIS

Purpose: Four patients presented after cataract surgery with delayed-o nset endophthalmitis caused by Acremonium kiliense with in vitro sensi tivity to amphotericin B. In all patients, ocular infection was recalc itrant to single-dose intravitreous amphotericin B injection. The auth ors reviewed the management of endophthalmitis caused by A. kiliense a nd presented treatment recommendations. Methods: The authors retrospec tively evaluated a cluster of four patients with delayed-onset postope rative endophthalmitis after phacoemulsification with posterior chambe r intraocular lens implantation. All patients underwent vitreous sampl ing, intravitreous injection of amphotericin B, and systemic administr ation of fluconazole. Pars plana vitrectomy was performed in all patie nts for management of either primary(1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens. Results: Wor sening infection developed in three of three eyes that underwent vitir eous aspiration with intravitreous injection of 5 mu g amphotericin B. These patients subsequently responded to vitrectomy followed by addit ional intravitreous amphotericin B injection. One eye underwent primar y vitrectomy and intravitreous injection of 7.5 mu g amphotericin B. A lthough treatment of the initial infection was successful, fungal kera titis developed in this patient 3 months after presentation. Visual ou tcome was variable, ranging from visual acuity of 20/25 to no light pe rception with follow-up of 2 years. Epidemiologic investigation sugges ted a common environmental source for the A. kiliense organisms. Concl usions: Single-dose administration of intravitreous amphotericin a was inadequate treatment for fungal endophthalmitis caused by A. kiliense . Vitrectomy with repeated intravitreous administration of amphoterici n B may be necessary to eradicate intraocular infection caused by this organism.