[Endogenous fungal endophthalmitis: results of antifungal treatment with and without vitrectomy].
BACKGROUND
Fungal endophthalmitis represents a significant cause of ocular morbidity, affecting in the majority of cases patients in poor general conditions. The eye is typically involved by hematogen dissemination, and the germ induces a chorioretinitis associated with an important panuveitis.


METHODS
Four patients were examined. They complained of a progressive reduction of vision, associated with photophobia. Ophthalmologic examination disclosed an important panuveitis. Investigations showed a fungal chorio-retinitis in all cases. Risk factors were intra-venous toxicomania, longterm parenteral nutrition and traumatism of the sinuses.


RESULTS
Vitreous cultures were positive for Candida albicans (3 patients) and for Aspergillus fumigatus (1 patient). Blood cultures were negative in the four cases. Three patients were treated with anti-fungal medication (fluconazole, itraconazole) associated with a vitrectomy by pars plana. One patient was treated by anti-fungal therapy only. Clinical evolution was satisfactory in all cases. Final vision was 10/10 in three cases and 5/10 in one. One patient developed a retinal detachment and an epiretinal membrane. Follow-up was 7 months (2-16 months).


CONCLUSIONS
The evolution of these four cases suggests that a rapid anti-fungal therapy associated with or without a vitrectomy represent a favourable therapeutic option when a fungal infection is suspected.
Bagnoud
M
M
Clinique d'Ophtalmologie, Hôpitaux Universitaires, Rue Alcide Jentzer 22, CH-1211 Genève.
Baglivo
E
E
Hengstler
J
J
Safran
A B
AB
Pournaras
C J
CJ
Leuenberger
P
P
D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000628:therapy*; D002177:Candidiasis / Q000628:therapy*; D003131:Combined Modality Therapy; D015841:Enophthalmos / Q000628:therapy*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D005451:Fluorescein Angiography; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014821:Vitrectomy
D017964:Itraconazole; D015725:Fluconazole