Vinekar Anand, Dogra Mangat R, Avadhani Kavitha, Gupta Vishali, Gupta Amod, Chakrabarti Arunaloke
Department of Ophthalmology, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Ophthalmol. 2014 Feb;62(2):136-40. doi: 10.4103/0301-4738.128588.
To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.
Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.
Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. 'Anatomical success' defined as preserved anatomy of the globe, and absence of signs of inflammation. Functional success defined as an attached retina and a best corrected visual acuity of better than 20/400.
Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re - PPV (median follow-up, 37 months). Pre-study defined criteria for successful 'anatomical' and 'functional' outcomes were achieved in 83.3% and 50% respectively.
This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.
报告在玻璃体切割术（PPV）和抗真菌治疗失败后复发性术后真菌性眼内炎（POFE）的处理方法。
印度北部的三级医疗转诊中心。回顾性、单机构、介入性病例系列研究。
纳入6例经微生物学证实的复发性术后真菌性眼内炎患者，这些患者对传统治疗无效。最终的复发通过人工晶状体（IOL）取出和再次PPV进行处理。主要观察指标包括眼球解剖结构的保留、视力和视网膜状态。“解剖学成功”定义为眼球解剖结构保留且无炎症迹象。“功能成功”定义为视网膜附着且最佳矫正视力优于20/400。
在6例POFE病例中，5例培养阳性[黄曲霉（1例）、烟曲霉（2例）、白色念珠菌（1例）和光滑念珠菌（1例）]，1例酵母涂片阳性。尽管平均进行了2.17次PPV和玻璃体内注射两性霉素B，但所有患者均复发（平均复发次数为4次）。IOL取出并再次PPV后未观察到复发（中位随访时间为37个月）。分别有83.3%和50%的患者达到了预先研究定义的“解剖学”和“功能”成功标准。
本报告强调了IOL取出与PPV联合应用在处理复发性POFE中的有效作用。
