To study whether immediate pars plana vitrectomy at the time of sampling vitreous for culture alter the visual and structural outcomes in fungal endophthalmitis.
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.
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).
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: firstname.lastname@example.org
Supported by Hyderabad Eye Research Foundation.
None of the authors has any conflicting interests to disclose.