Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.
Curr Eye Res. 2009 Nov;34(11):988-95. doi: 10.3109/02713680903254822.
This study aimed to report an outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery.
The study was designed retrospectively to review microbiologic and medical records of eight cases of endophthalmitis caused by Fusarium species after cataract surgery performed in the same operating room and on the same date by different surgeons at Beyoğlu Eye Training and Research Hospital in Istanbul, Turkey. Seven patients had phacoemulsification and intraocular lens implantation surgery. Intracapsular cataract extraction was performed in one patient. The common feature of these surgeries was the use of intracameral injections of cefuroxime (1 mg in 0.1-ml balanced salt solution-BSS) solutions, which were preoperatively prepared from the same BSS bottle.
The duration between cataract surgery and the diagnosis of endophthalmitis was four days. Aqueous and vitreous specimens obtained from the patients grew fungus colonies that were identified according to their morphologic features and considered to be Fusarium solani. All patients underwent multiple vitrectomies with silicone oil injections. Patients were given local and systemic antifungal agents (amphotericin B and voriconazole). One patient with corneal involvement underwent evisceration despite a variety of treatments. One patient with unregulated diabetes was prephthisic without recurrence of infection. The final visual acuity of patients was between light perception and 20/100.
Fusarium should be considered in the differential diagnosis of early-onset endophthalmitis after cataract surgery. An aggressive treatment with local and systemic antifungal agents and multiple vitrectomies with silicone oil injection is helpful in the management of postoperative early-onset Fusarium endophthalmitis. In the prevention of such outbreaks, it is important to use solutions prepared differently for each patient.
本研究旨在报告白内障手术后由镰刀菌属引起的早发性眼内炎爆发。
本研究设计为回顾性研究，回顾了土耳其伊斯坦布尔 Beyoğlu 眼训练和研究医院同一手术室和同一天由不同外科医生进行的白内障手术后由镰刀菌属引起的 8 例眼内炎的微生物学和病历。7 例患者行超声乳化白内障吸除术和人工晶状体植入术。1 例患者行囊内白内障摘除术。这些手术的共同特点是使用头孢呋辛（1mg 溶于 0.1ml 平衡盐溶液-BSS）的前房内注射，这些溶液是从同一 BSS 瓶中预先配制的。
白内障手术后至眼内炎诊断的时间为 4 天。从患者获得的房水和玻璃体标本中生长出真菌菌落，根据其形态学特征进行鉴定，并被认为是茄病镰刀菌。所有患者均接受多次玻璃体切除术和硅油注入。患者给予局部和全身抗真菌药物（两性霉素 B 和伏立康唑）。尽管进行了多种治疗，但 1 例合并角膜受累的患者仍进行了眼内容剜除术。1 例患有未控制糖尿病的患者因感染未复发而处于假性前葡萄肿期。患者的最终视力在光感至 20/100 之间。
白内障手术后应考虑早发性眼内炎的鉴别诊断。局部和全身抗真菌药物联合多次玻璃体切除术和硅油注入有助于治疗术后早发性镰刀菌眼内炎。为预防此类暴发，使用为每位患者分别配制的溶液非常重要。
