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RISK FACTORS, TREATMENT STRATEGIES, AND OUTCOMES OF ENDOPHTHALMITIS ASSOCIATED WITH SEVERE FUNGAL KERATITIS

Wan, Lei MD*,†; Cheng, Jun MD, PhD; Zhang, Jing MD*,†; Chen, Nan MD, PhD; Gao, Yan MD, PhD; Xie, Li-Xin MD

doi: 10.1097/IAE.0000000000002112
Original Study
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Purpose: To investigate risk factors, treatment strategies, and outcomes of endophthalmitis associated with severe fungal keratitis.

Methods: Data from 392 patients diagnosed with fungal keratitis were retrospectively examined. Patients had severe disease that was refractory to topical or systemic antifungal therapy, and the infection involved the endothelium or perforated the cornea. The incidence and risk factors for endophthalmitis, and treatment outcomes were evaluated.

Results: Thirty-seven of 392 patients (9.4%) had endophthalmitis. Multivariate logistic regression revealed the following risk factors for endophthalmitis: topical steroid use (odds ratio [OR] = 6.35, 95% confidence interval [CI]: 2.01–20.08), previous corneal laceration suturing (OR = 5.05, 95% CI: 1.11–22.93), large corneal ulcer size (≥10-mm diameter; OR = 4.43, 95% CI: 1.71–11.50), hypopyon (OR = 11.05, 95% CI: 2.12–57.55), and aphakia (OR = 15.45, 95% CI: 1.59–149.82). Thirty of the 37 eyes (81.1%) with endophthalmitis were saved by penetrating keratoplasty, vitrectomy, or intravitreal antifungal injection; 7 eyes (18.9%) were eviscerated.

Conclusion: Most patients with endophthalmitis secondary to corneal fungal infection were successfully managed by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Multiple risk factors for endophthalmitis were identified. Timely diagnosis and risk factor assessment were essential for ensuring early surgical intervention for fungal keratitis–related endophthalmitis.

The incidence of endophthalmitis associated with severe fungal keratitis was 9.4%. Infection was successfully controlled in 81.1% of eyes by penetrating keratoplasty, vitrectomy, or intravitreal antifungal therapy. Identified risk factors for endophthalmitis included topical steroid use, previous corneal laceration suturing, large corneal ulcer size, hypopyon, and aphakia.

*Medical College, Qingdao University, Qingdao, China; and

Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.

Reprint requests: Li-Xin Xie, MD, Qingdao Eye Hospital, Shandong Eye Institute, 5 Yanerdao Road, Qingdao 266071, China; e-mail: lixin_xie@hotmail.com

Supported by the Innovation Project of Shandong Academy of Medical Sciences.

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.