Small Kent W, Tran Elaine M, Garabetian Christine A, Avetisjan Jessica, Walsh Thomas J, Shaya Fadi S
Macula and Retina Institute, Los Angeles and Glendale, California; Molecular Insight Research Foundation, Los Angeles and Glendale, California.
Macula and Retina Institute, Los Angeles and Glendale, California; Molecular Insight Research Foundation, Los Angeles and Glendale, California; Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Ophthalmol Retina. 2019 Feb;3(2):133-139. doi: 10.1016/j.oret.2018.09.009. Epub 2018 Sep 21.
To report the 5-year outcome of an outbreak of Bipolaris hawaiiensis fungal endophthalmitis caused by contamination of intravitreal triamcinolone from Franck's Compounding Pharmacy in Ocala, Florida.
Retrospective case series.
Twenty-three patients (n = 25 eyes).
Data was collected from the practice of a single retina specialist in Los Angeles (K.W.S) and a retina practice in New York City. Intravitreal injections of triamcinolone obtained from a single lot were subsequently found to be contaminated with Bipolaris hawaiiensis.
Visual acuity; presence of vitreous cells, anterior chamber cells, or both; and detection of fungi or fungal elements in samples obtained by vitreous needle aspiration or vitreous biopsy.
Fungal endophthalmitis developed in 92% (23/25) of eyes. Despite aggressive local and systemic long-term therapy, severe visual loss resulted in the majority of treated eyes and the enucleated eyes showed evidence of hyphae.
These reported cases of Bipolaris hawaiiensis endophthalmitis provide important messages for clinicians and regulatory agencies. First, patients treated with high-dose, long-term, orally administered voriconazole appeared to achieve better outcomes in treatment of Bipolaris endophthalmitis. Second, treated eyes may still show signs of deterioration, indicating the potential survival of causative organisms or fibrosis encapsulating the ciliary body, leading to hypotony. Third, several parallels can be drawn between this outbreak and the fungal meningitis outbreak after Exserohilum rostratum contamination of methylprednisolone by the New England Compounding Center.
报告由佛罗里达州奥卡拉市弗兰克配制药房的玻璃体内注射曲安奈德污染导致的夏威夷双极霉真菌性眼内炎暴发的5年结局。
回顾性病例系列。
23例患者（25只眼）。
数据收集自洛杉矶的一位视网膜专科医生（K.W.S）的诊所和纽约市的一家视网膜诊所。随后发现从同一批次获得的玻璃体内注射用曲安奈德被夏威夷双极霉污染。
视力；玻璃体细胞、前房细胞或两者的存在情况；以及通过玻璃体穿刺针抽吸或玻璃体活检获得的样本中真菌或真菌成分的检测。
92%（23/25）的眼发生了真菌性眼内炎。尽管进行了积极的局部和全身长期治疗，但大多数接受治疗的眼仍出现严重视力丧失，而摘除眼球的眼中显示有菌丝迹象。
这些报告的夏威夷双极霉性眼内炎病例为临床医生和监管机构提供了重要信息。第一，接受高剂量、长期口服伏立康唑治疗的患者在治疗夏威夷双极霉性眼内炎方面似乎取得了更好的疗效。第二，接受治疗的眼仍可能出现病情恶化迹象，表明致病生物体可能存活或睫状体被纤维化包裹，导致低眼压。第三，此次暴发与新英格兰配制中心的甲基强的松龙被喙突埃里希霉污染后发生的真菌性脑膜炎暴发有几个相似之处。
