Das Taraprasad, Agarwal Manisha, Anand Appakkudal R, Behera Umesh C, Bhende Muna, Das Anthony Vipin, Dasgupta Debarati, Dave Vivek P, Gandhi Jaishree, Gunasekaran Rameshkumar, Joseph Joveeta, Kulkarni Sucheta, Lalitha Prajna, Mahendrakar Priyanka A, Mitra Sanchita, Mohamed Ashik, Muralidhar Alankrita, Nimeshika Pillutla L, Prashanthi MTech Gumpalli S, Sen Alok, Sharma Savitri, Uday Prithviraj
Srimati Kanuri Santhamma Center for Vitreo-Retinal Diseases, Kallam Anji Reddy Campus, L. V. Prasad Eye Institute, Hyderabad, India.
Retina and Vitreous Department, Dr. Shroff's Charity Eye Hospital, New Delhi, India.
Ophthalmol Retina. 2022 Mar;6(3):243-251. doi: 10.1016/j.oret.2021.09.006. Epub 2021 Sep 20.
To evaluate the clinical and microbiological features of a large cohort with culture-confirmed fungal endophthalmitis across India.
Cross-sectional, hospital-based, retrospective medical record review.
Seven large tertiary eye care centers from different regions of India.
Patient data were pooled from electronic or physical medical records of each participating center. Fellowship-trained vitreoretinal specialists clinically managed all patients, and in-house microbiology laboratories performed all microbiological workups. The clinical and microbiological procedures were broadly uniform across all participating centers. The essential treatment consisted of vitreous surgery as well as intravitreal and systemic therapies with antifungal agents.
Clinical outcome of the causative event and causative fungus.
In the period from 2005 to 2020, 7 centers treated 3830 cases of culture-proven endophthalmitis, and of these, 19.1% (n = 730) were cases of culture-confirmed fungal endophthalmitis. It included 46.9% cases of postoperative (87.4% postcataract surgery), 35.6% of traumatic, and 17.5% of endogenous endophthalmitis. The fungi included 39.0% of Aspergillus (high prevalence in central, east, and south zones), 15.1% of Candida (high prevalence in west zone), and 15.9% of Fusarium (high prevalence in north and west zones). The time to symptom development was between 1 week and 4 weeks in more than one third of the patients, except in patients with traumatic endophthalmitis. Less than half of the patients had hypopyon on presentation. The presenting visual acuity (PVA) in most patients was <20/400. Nearly all patients needed vitrectomy and an average of 2 intravitreal injections of antifungal agents. At least 10% of eyes needed therapeutic keratoplasty, and up to 7% of eyes were eviscerated. After treatment, the final (best corrected) visual acuity (FVA) was >20/400 in 30.5% (n = 222) of eyes and >20/40 in 7.9% (n = 58) of eyes, and 12% (n = 88) of eyes lost light perception. A post hoc analysis showed the male sex to be significantly more associated with traumatic endophthalmitis than with postoperative (P < 0.0001) and endogenous (P = 0.001) endophthalmitis, more isolation of Candida species in patients with endogenous endophthalmitis than in those with postoperative (P = 0.004) and traumatic (P < 0.0001) endophthalmitis, better PVA in eyes with Candida species infection (P < 0.0001), and poorer FVA in eyes with Aspergillus species infection.
Fungal endophthalmitis is not uncommon in India. The inclusion of antifungal agents with antibiotics as the first empirical intravitreal therapy before microbiological confirmation should be considered when a fungal infection is suspected.
评估印度一大群经培养确诊的真菌性眼内炎患者的临床和微生物学特征。
基于医院的横断面回顾性病历审查。
来自印度不同地区的7家大型三级眼科护理中心。
从每个参与中心的电子或纸质病历中汇总患者数据。接受过 fellowship 培训的玻璃体视网膜专科医生对所有患者进行临床管理，内部微生物实验室进行所有微生物学检查。所有参与中心的临床和微生物学程序基本一致。基本治疗包括玻璃体手术以及玻璃体内和全身使用抗真菌药物治疗。
致病事件和致病真菌的临床结局。
在2005年至2020年期间，7个中心治疗了3830例经培养证实的眼内炎病例，其中19.1%（n = 730）为经培养确诊的真菌性眼内炎病例。其中包括46.9%的术后病例（87.4%为白内障术后）、35.6%的外伤性病例和17.5%的内源性眼内炎病例。真菌包括39.0%的曲霉菌（在中部、东部和南部地区患病率高）、15.1%的念珠菌（在西部地区患病率高）和15.9%的镰刀菌（在北部和西部地区患病率高）。除外伤性眼内炎患者外，超过三分之一的患者症状出现时间在1周至4周之间。不到一半的患者就诊时出现前房积脓。大多数患者的就诊视力（PVA）<20/400。几乎所有患者都需要进行玻璃体切除术，平均需要2次玻璃体内注射抗真菌药物。至少10%的眼睛需要治疗性角膜移植术，高达7%的眼睛被摘除眼球。治疗后，最终（最佳矫正）视力（FVA）>20/400的眼睛占30.5%（n = 222），>20/40的眼睛占7.9%（n = 58），12%（n = 88）的眼睛失去光感。事后分析显示，男性与外伤性眼内炎的相关性显著高于术后（P < 0.0001）和内源性（P = 0.001）眼内炎，内源性眼内炎患者念珠菌属的分离率高于术后（P = 0.004）和外伤性（P < 0.0001）眼内炎患者，念珠菌属感染的眼睛PVA较好（P < 0.0001），曲霉菌属感染的眼睛FVA较差。
真菌性眼内炎在印度并不罕见。当怀疑有真菌感染时，应考虑在微生物学确认之前将抗真菌药物与抗生素联合作为首次经验性玻璃体内治疗。
