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ROLE OF EARLY VITRECTOMY IN THE TREATMENT OF FUNGAL ENDOPHTHALMITIS

Behera, Umesh, Chandra, MS; Budhwani, Monica, MBBS; Das, Taraprasad, MD; Basu, Soumyava, MS; Padhi, Tapas, Ranjan, MS; Barik, Manas, Ranjan, MSc; Sharma, Savitri, MD

doi: 10.1097/IAE.0000000000001727
Original Study: PDF Only

Purpose: To study whether immediate pars plana vitrectomy at the time of sampling vitreous for culture alter the visual and structural outcomes in fungal endophthalmitis.

Methods: Surgical results of 66 consecutive patients with culture-positive fungal endophthalmitis attending a tertiary eye care hospital in eastern India were analyzed. Based on the timing of vitrectomy, they were divided into 2 groups: Group 1—immediate vitrectomy (n = 31) and Group 2—diagnostic vitrectomy alone (n = 35) as the first-line intervention. The demographics, clinical features, and visual and structural outcomes were compared between the groups.

Results: The proportion of postoperative (54.83 vs. 51.42%), traumatic (29.03 vs. 34.28%), and endogenous (16.12 vs. 14.28%) endophthalmitis and clinical signs such as pain (54.83 vs. 60%), lid edema (48.38 vs. 48.57%), conjunctival congestion (87.09 vs. 94.28%), and corneal involvement (87.09 vs. 80%) in Groups 1 and 2, respectively, were comparable. Logarithm of the minimum angle of resolution vision improvement in Group 1 was significant (P = 0.0278) though there was no statistically significant difference in posttreatment vision between the groups (P = 0.322). Phthisis was seen in 25.8% in Group 1 and 25.7% in Group 2 (P = 0.993). Aspergillus species was the most common fungal pathogen isolated. Early vitrectomy plus intravitreal antifungals in a subset of clinically suspected fungal endophthalmitis resulted in statistically significant visual improvement over diagnostic vitrectomy plus intravitreal antifungals (P = 0.013).

Conclusion: A strong clinical suspicion that translates into early vitrectomy plus intravitreal antifungal antibiotics leads to favorable visual and structural outcomes. A long wait till microbiological confirmation to institute antifungal therapy may result in poorer outcome.

Fungal endophthalmitis with its indistinguishable clinical features from bacterial endophthalmitis and slow growth on culture poses a treatment challenge. Our analysis found that it was not early vitrectomy but a strong clinical suspicion and institution of antifungals early in the course of the disease that resulted in a favorable outcome.

Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, India.

Reprint requests: Umesh Chandra Behera, L V Prasad Eye Institute, Patia, Bhubaneswar 751024, Odisha, India; e-mail: umeshcbehera@gmail.com

Supported by Hyderabad Eye Research Foundation.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.