Management of postoperative Acremonium endophthalmitis.
OBJECTIVE
Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by Acremonium kiliense with in vitro sensitivity to amphotericin B. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin B injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations.


METHODS
The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin B, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients 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
Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin B. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin B injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin B. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms.


CONCLUSIONS
Single-dose administration of intravitreous amphotericin B was inadequate treatment for fungal endophthalmitis caused by A. kiliense. Vitrectomy with repeated intravitreous administration of amphotericin B may be necessary to eradicate intraocular function caused by this organism.
Weissgold
D J
DJ
Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA.
Maguire
A M
AM
Brucker
A J
AJ
D000164:Acremonium / Q000302:isolation & purification; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000382:microbiology; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007267:Injections; D007634:Keratitis / Q000188:drug therapy / Q000382:microbiology; D007910:Lenses, Intraocular; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000209:etiology; D018918:Phacoemulsification / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000935:Antifungal Agents; D000666:Amphotericin B