title: Management of recurrent postoperative fungal endophthalmitis.
abstract: OBJECTIVE
  To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.
  
  
  METHODS
  Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.
  
  
  METHODS
  Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. 'Anatomical success' defined as preserved anatomy of the globe, and absence of signs of inflammation. Functional success defined as an attached retina and a best corrected visual acuity of better than 20/400.
  
  
  RESULTS
  Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re - PPV (median follow-up, 37 months). Pre-study defined criteria for successful 'anatomical' and 'functional' outcomes were achieved in 83.3% and 50% respectively.
  
  
  CONCLUSIONS
  This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.
authors.forename: Anand
authors.initials: A
authors.lastname: Vinekar
authors.affiliation: Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Mangat R
authors.initials: MR
authors.lastname: Dogra
authors.forename: Kavitha
authors.initials: K
authors.lastname: Avadhani
authors.forename: Vishali
authors.initials: V
authors.lastname: Gupta
authors.forename: Amod
authors.initials: A
authors.lastname: Gupta
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B