Yang Yun Sik
Department of Ophthalmology, Wonkwang University School of Medicine and Hospital, #344-2 Sinyongdong, Iksan 570-711, Korea.
Korean J Ophthalmol. 2009 Sep;23(3):159-63. doi: 10.3341/kjo.2009.23.3.159. Epub 2009 Sep 8.
Postoperative endophthalmitis is a dreaded outcome of any intraocular surgery. Fungal endophthalmitis is a particularly severe complication that poses a significant threat of blindness. We experienced seven consecutive cases of postoperative fungal endophthalmitis stemming from a single local clinic in which extensive early intervention resulted in favorable final visual acuity.
The present study is retrospective observational case series of fungal endophthalmitis. The initial case, as diagnosed by fungal culture, resulted in blindness. In the ensuing eight months, seven consecutive cases were referred to our institution. All were presumed to be fungal endophthalmitis as the cases possessed similar inflammatory findings to the preceding case and occurred in the same environment. Extensive surgical and antifungal treatment was immediately administered, including complete vitrectomy with removal of the intraocular lens and lens capsule and Amphotericin B injections.
Retinal infiltration was identified in three cases and the lesion site was photocoagulated with an endolaser. All cases were confirmed fungal endophthalmitis by culture (4 cases: Candida parapsilosis, one case each: Fusarium, Acremonium, Candida tropicalis) and five cases required secondary intraocular lens implantation. Final corrected visual acuity ranged from 20/20 to 40/200 by the Snellen chart.
Early extensive surgical intervention and antifungal agent administration may result in favorable visual outcomes in patients with fungal endophthalmitis following cataract surgery.
术后眼内炎是任何眼内手术令人恐惧的结果。真菌性眼内炎是一种特别严重的并发症，对失明构成重大威胁。我们连续遇到了7例术后真菌性眼内炎病例，这些病例均来自同一家当地诊所，广泛的早期干预使最终视力良好。
本研究是真菌性眼内炎的回顾性观察病例系列。首例经真菌培养确诊的病例导致失明。在随后的八个月里，连续有7例病例转诊至我们机构。由于这些病例与前一例具有相似的炎症表现且发生在相同环境中，故均被推测为真菌性眼内炎。立即给予广泛的手术和抗真菌治疗，包括完全玻璃体切除术，同时取出人工晶状体和晶状体囊，并注射两性霉素B。
3例发现视网膜浸润，病变部位用眼内激光进行了光凝。所有病例经培养均确诊为真菌性眼内炎（4例：近平滑念珠菌，1例分别为镰刀菌、枝顶孢霉、热带念珠菌），5例需要二期人工晶状体植入。根据斯内伦视力表，最终矫正视力范围为20/20至40/200。
对于白内障手术后发生真菌性眼内炎的患者，早期进行广泛的手术干预和给予抗真菌药物可能会带来良好的视力结果。
