Management of recurrent postoperative fungal endophthalmitis.

AIM

To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.

SETTINGS AND DESIGN

Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.