Exogenous fungal endophthalmitis in a potato farm worker

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Fungal Endophthalmitis: A Comprehensive Review

Endophthalmitis is a serious ophthalmologic condition involving purulent inflammation of the intraocular spaces. The underlying etiology of infectious endophthalmitis is typically bacterial or fungal. The mechanism of entry into the eye is either exogenous, involving seeding of an infectious source from outside the eye (e.g., trauma or surgical complications), or endogenous, involving transit of an infectious source to the eye via the bloodstream. The most common organism for fungal endophthalmitis is Candida albicans. The most common clinical manifestation of fungal endophthalmitis is vision loss, but other signs of inflammation and infection are frequently present. Fungal endophthalmitis is a clinical diagnosis, which can be supported by vitreous, aqueous, or blood cultures. Treatment involves systemic and intravitreal antifungal medications as well as possible pars plana vitrectomy. In this review, we examine these essential elements of understanding fungal endophthalmitis as a clinically relevant entity, which threatens patients’ vision.

Fungal endophthalmitis

The question of the pathogenesis and development of fungal endophthalmitis is an urgent research topic Purpose. Evaluation of the clinical effectiveness of treatment of patients with fungal endophthalmitis over the past 5 years using the developed surgical technology. Material and methods. In the period 2016-2021, 5 patients with fungal endophthalmitis were treated. With the fungal etiology of endophthalmitis, one patient was after a penetrating wound, 4-after corneal microtraumas with the development of keratouveitis (all after using contact lenses). Surgical treatment included taking intraocular material for examination, performing vitrectomy in the maximum possible volume, tamponade of the vitreal cavity with perfluorodecalin (for 5-14 days) and intravitreal administration of amphotericin B in 10 mcg in 0.1 ml. Results. As a result of treatment of fungal endophthalmitis, it was possible to preserve the eye as an organ in 3 patients (60%), to preserve visual functions in 1 patient (20%). Conclusion. Fungal endophthalmitis is a severe pathology of the visual organ. The prognosis for the preservation of visual functions is unfavorable, the preservation of the eye is doubtful. Key words: fungal endophthalmitis, vitrectomy, perfluorodecalin, amphotericin B.

A 10-year-old immunocompetent girl with endogenous fungal endophthalmitis: Report of a case and review of the literature

Endogenous Endophthalmitis (EE) is a rare cause of blindness in the pediatric age group and this may account for the paucity of management guidelines in the literature. In this report, we describe our experience with a 10-year-old immunocompetent female who developed EE and became blind because of rapidly progressive and destructive inflammatory changes in her eye in spite of seemingly timely treatment.

Invasive Klebsiella syndrome with coexisting fungal endophthalmitis

Endogenous endophthalmitis accounts for approximately 5 – 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a “string of pearls” present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally.