INTRAOCULAR CANDIDIASIS IN PATIENTS WITH CANDIDEMIA - CLINICAL IMPLICATIONS DERIVED FROM A PROSPECTIVE MULTICENTER STUDY

Purpose: Intraocular infection caused by Candida species can have deva stating visual consequences. With the emergence of Candida as a major nosocomial pathogen, the authors investigated the prevalence of ocular lesions in patients with candidemia and evaluated risk factors for ey e involvement. Methods: This study is a prospective, multicentered, ob servational design. One hundred eighteen patients with candidemia were evaluated by the infectious disease service and received indirect oph thalmologic examination within 72 hours of a reported positive blood c ulture. Ocular findings were classified on the basis of objective, pre determined criteria. Candida chorioretinitis was defined as the presen ce of focal, white, infiltrative chorioretinal lesions without vitreal involvement. Candida endophthalmitis was defined as chorioretinitis w ith extension into the vitreous or intravitreal ''fluff balls.'' Resul ts: In contrast to previous studies of patients with candidemia citing prevalence rates of endophthalmitis approaching 40%, no patients were shown to have endophthalmitis. Candida chorioretinitis was seen in 9% of the patients, all of whom received antifungal agents. The observat ion that chorioretinitis never progressed to endophthalmitis suggests that systemic antifungal agents provided adequate ocular therapy. Risk factors for Candida chorioretinitis include fungemia with Candida alb icans (versus nonalbicans species), multiple positive blood cultures, visual symptoms, and immunosuppression. Twenty percent of patients had nonspecific ocular lesions not directly related to infection. Conclus ion: Patients with candidemia who have the risk factors noted above wa rrant formal ophthalmologic examination.