Fungal infection of sutureless self-sealing incision for cataract surgery.
OBJECTIVE
To report the clinical picture and outcome of fungal infection of self-sealing wounds in cataract surgery.


METHODS
Retrospective noncomparative case series.


METHODS
Seven postoperative cataract patients.


METHODS
Seven consecutive patients who underwent cataract surgery in different locations in India and developed microbiologically proven fungal infection of the surgical wound were included. All were managed at a tertiary eye care center in India between May 2001 and April 2002.


METHODS
The data reviewed included patient age, gender, onset of symptoms after surgery, examination findings at the time of onset of symptoms and referral, laboratory workup, treatment, and outcome. The cataract surgeons involved were contacted to determine their cataract practice and to determine any possible breach in the sterile technique.


RESULTS
The median interval to onset of symptoms after cataract surgery was 5.0 days (mean, 5.8 days; range, 3-9 days). The initial diagnoses at the time of onset of symptoms were keratitis (n = 3), scleritis (n = 1), and excessive anterior chamber reaction (n = 3). The last 4 patients were treated with topical and/or systemic corticosteroid therapy before referral. All cases subsequently developed deep keratitis. Specimens for microbiology workup were obtained by scrapings (n = 6), corneoscleral biopsy (n = 4), and anterior chamber paracentesis (n = 4). Organisms identified were Aspergillus flavus (n = 2), Aspergillus terreus (n = 2), Aspergillus spp. (n = 2), and Candida albicans (n = 1). The infection resolved with medical therapy in 2 cases; the final visual acuity was 20/125 in one case and 20/20 in the other case. The infection progressed to endophthalmitis in 5 eyes, resulting in complete loss of vision. The source of infection could not be identified in any case.


CONCLUSIONS
Infection of self-sealing tunnel incision for cataract surgery is a diagnostic and therapeutic challenge.
Cornea Service, L. V. Prasad Eye Institute, Hyderabad, India. prashant@lvpeye.stph.net
Prashant
P
Garg
S
S
Mahesh
Aashish K
AK
Bansal
Usha
U
Gopinathan
Gullapalli N
GN
Rao
D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D003320:Corneal Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010866:Natamycin / Q000627:therapeutic use; D018918:Phacoemulsification; D012189:Retrospective Studies; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D013536:Suture Techniques
D000666:Amphotericin B; D010866:Natamycin; D015725:Fluconazole; D007654:Ketoconazole