Leung Ella H, Kuriyan Ajay E, Flynn Harry W, Relhan Nidhi, Huang Laura C, Miller Darlene
Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
Department of Ophthalmology, University of Miami Miller School of Medicine/Bascom Palmer Eye Institute, Miami, Florida.
Am J Ophthalmol. 2016 Dec;172:45-50. doi: 10.1016/j.ajo.2016.09.014. Epub 2016 Sep 16.
To report the clinical settings, microbiological isolates, and best-corrected visual acuities (BCVA) of patients with persistently culture-positive exogenous fungal endophthlamitis.
Retrospective consecutive case series.
Setting: Tertiary referral center.
Sixteen eyes of 16 patients with at least 2 consecutive positive vitreous cultures between 1981 and 2015.
Intravitreal antifungal injection, pars plana vitrectomy (PPV).
Clinical settings, microbiologic isolates, BCVA.
The most common clinical settings were after cataract surgery (9/16, 56%), glaucoma surgery (4/16, 25%), and trauma (2/16, 13%). The most common single fungal isolate was Candida (4/16, 25%), but 75% of all isolates were molds. Treatment for presumed bacterial endophthalmitis was given initially in 14 patients (88%). All patients underwent a vitrectomy during the course of their treatment, and all received intravitreal or systemic antifungal therapy. The mean initial BCVA was 1.76 ± 0.9 logMAR (Snellen equivalent ≈20/1200), and the mean final BCVA was 1.84 ± 1.2 logMAR (≈20/1400, P = .83). The 9 patients (56%) who had intraocular lens (IOL) and capsular bag removals had better final BCVAs than those who did not (P = .011). The BCVAs were similar in eyes with yeast and mold (P = .37). The visual acuity at the last follow-up was ≥20/40 in 13% (2/16), ≥20/400 in 50% (8/16), and no light perception in 25% (4/16).
Candida was the single most common isolate, but the majority of isolates were molds. Eyes managed with PPV and removal of the IOL and capsular bag had better visual outcomes. Persistently culture-positive fungal endophthalmitis was associated with poor final visual acuities.
报告持续培养阳性的外源性真菌性眼内炎患者的临床情况、微生物分离株及最佳矫正视力（BCVA）。
回顾性连续病例系列研究。
研究地点为三级转诊中心。
1981年至2015年间16例患者的16只眼，玻璃体培养至少连续2次呈阳性。
玻璃体腔内抗真菌注射、玻璃体切割术（PPV）。
临床情况、微生物分离株、BCVA。
最常见的临床情况为白内障手术后（9/16，56%）、青光眼手术后（4/16，25%）和外伤后（2/16，13%）。最常见的单一真菌分离株为念珠菌（4/16，25%），但所有分离株的75%为霉菌。14例患者（88%）最初接受了疑似细菌性眼内炎的治疗。所有患者在治疗过程中均接受了玻璃体切割术，且均接受了玻璃体腔内或全身抗真菌治疗。初始平均BCVA为1.76±0.9 logMAR（Snellen等效值≈20/1200），最终平均BCVA为1.84±1.2 logMAR（≈20/1400，P = 0.83）。9例（56%）行人工晶状体（IOL）及囊袋摘除术的患者最终BCVA优于未行该手术者（P = 0.011）。酵母菌和霉菌感染的眼的BCVA相似（P = 0.37）。末次随访时视力≥20/40者占13%（2/16），≥20/400者占50%（8/16），无光感者占25%（4/16）。
念珠菌是最常见的单一分离株，但大多数分离株为霉菌。接受PPV及IOL和囊袋摘除术治疗的眼视力预后较好。持续培养阳性的真菌性眼内炎最终视力较差。
