ENDOGENOUS ASPERGILLUS ENDOPHTHALMITIS - CLINICAL-FEATURES AND TREATMENT OUTCOMES

Objective: This study evaluated the clinical features and treatment ou tcomes in patients with endogenous Aspergillus endophthalmitis. Design : The study design was a multicenter retrospective chart review. Parti cipants: Ten patients (12 eyes) with culture-proven endogenous Aspergi llus endophthalmitis treated by 1 of the authors were studied. Interve ntion: Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were per formed. Main Outcome Measures: Elimination of endogenous Aspergillus e ndophthalmitis and Snellen visual acuity, best corrected, were measure d. Results: All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitriti s was present in all 12 eyes. In 8 of 12 eyes, a central macular chori oretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid t herapy. One of these patients with chronic asthma also was abusing int ravenous drugs. Overall, six patients (six eyes) had a history of intr avenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars pl ana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was admi nistered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuiti es were 20/25 to 20/200. In eight eyes with initial central macular in volvement, final visual acuities were 20/400 in three eyes and 5/200 o r less in four eyes. Two painful eyes with marked inflammation, hypoto ny, and retinal detachment were enucleated, Conclusions: Endogenous As pergillus endophthalmitis usually has an acute onset of intraocular in flammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intr avitreous amphotericin B is capable of eliminating the ocular infectio n, the visual outcome generally is poor, especially when there is dire ct macular involvement.