title: Exogenous fungal endophthalmitis: microbiology and clinical outcomes.
abstract: OBJECTIVE
  To report the fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous fungal endophthalmitis.
  
  
  METHODS
  Retrospective, single institution, consecutive case series.
  
  
  METHODS
  All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous fungal endophthalmitis.
  
  
  METHODS
  Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for fungal organisms and clinically diagnosed exogenous endophthalmitis.
  
  
  METHODS
  Fungal isolates, treatment strategies, visual acuity, and rate of enucleation.
  
  
  RESULTS
  Culture-positive exogenous fungal endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antifungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients.
  
  
  CONCLUSIONS
  This report highlights the differences between the clinical categories of exogenous fungal endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common fungal genera varied by clinical category. Amphotericin B was the most commonly used antifungal agent, but most cases were treated with at least 3 different antifungal agents. Final visual outcomes were variable, with the open-globe-associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. cwykoff@med.miami.edu
authors.forename: Charles C
authors.initials: CC
authors.lastname: Wykoff
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
authors.forename: Ingrid U
authors.initials: IU
authors.lastname: Scott
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Alfonso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D009877:Endophthalmitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015353:Eye Enucleation; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D015807:Eye Injuries, Penetrating / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D000935:Antifungal Agents