title: Persistently Vitreous Culture-Positive Exogenous Fungal Endophthalmitis.
abstract: OBJECTIVE
  To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis.
  
  
  METHODS
  Retrospective consecutive case series.
  
  
  METHODS
  Setting: Tertiary referral center.
  
  
  METHODS
  Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015.
  
  
  METHODS
  Intravitreal antifungal injection, pars plana vitrectomy (PPV).
  
  
  METHODS
  Clinical settings, microbiologic isolates, BCVA.
  
  
  RESULTS
  The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P = .83). The 9 patients (56%) who had intraocular lens (IOL) and capsular bag removals had better final BCVAs than those who did not (P = .011). The BCVAs were similar in eyes with yeast and mold (P = .37). The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16).
  
  
  CONCLUSIONS
  Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Ella H
authors.initials: EH
authors.lastname: Leung
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Ajay E
authors.initials: AE
authors.lastname: Kuriyan
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida. Electronic address: hflynn@med.miami.edu.
authors.forename: Harry W
authors.initials: HW
authors.lastname: Flynn
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Relhan
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Darlene
authors.initials: D
authors.lastname: Miller
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000382:microbiology*; D005260:Female; D005500:Follow-Up Studies; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014821:Vitrectomy; D014822:Vitreous Body / Q000000981:diagnostic imaging / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents