Fungal endophthalmitis following cataract surgery: Clinical presentation, microbiological spectrum, and outcome

PURPOSE: To determine the clinical presentation, microbiological spectrum, and outcome in cases of fungal endophthalmitis following cataract surgery. DESIGN: Observational case series. METHODS: Setting: Tertiary referral hospital. PATIENTS: Retrospective analysis of 27 cases of smear- and culture,proven f ungal endophthalmitis. INTERVENTION: Pars plana. vitrectomy in 18 eyes, where the corneal conditio n did not preclude the same. All eyes received intravitreal amphotericin B and dexamethasone along with systemic antifungal agents. MAIN OUTCOME MEASURES: Functional success: Final visual acuity of 3/60 or b etter with attached retina. Anatomical success: Final visual acuity of bett er than light perception with preserved anatomy of globe. RESULTS: The majority of the eyes (22 of the 27) had early onset and diffus e presentation (that is, anterior segment as well as posterior vitreous exu dates). Substantial corneal involvement was seen in 14 eyes (51.85%). Asper gillus sp. was the most common isolate. Multivariate analysis using forward stepwise logistic regression showed corneal involvement as the single most important risk factor in determining final visual outcome (P = .0429). CONCLUSIONS: Early onset and diffuse presentation, which mimics bacterial e ndophthalmitis, stresses the importance of both bacterial and fungal cultur es from intraocular fluids to reach a diagnosis apart from the clinical jud gment. Corneal involvement was the most important predictor of outcome in c ases of fungal endophthalmitis. (C) 2001 by Elsevier Science Inc. All right s reserved.