Sukriti Eye Clinic, Lucknow, Uttar Pradesh, India.
Indian J Ophthalmol. 2022 Nov;70(11):4004-4009. doi: 10.4103/ijo.IJO_1938_22.
The aim of this study was to present the signs, symptoms, management, and outcome of a series of cases of cluster endophthalmitis caused by a multi-drug resistant fungus, Trichosporon.
This was a retrospective, non-randomized, consecutive interventional case series. Ten cases of postoperative endophthalmitis operated by a surgeon on three consecutive operation theater (OT) days presented 3-5 months after their surgery. All cases were microbiologically confirmed. The pathogen was found to be resistant to most antifungals, including amphotericin B. The cases had a latent period of around 45 days. Management of endophthalmitis included intravitreal injections, anterior chamber (AC) lavage, Pars Plana vitrectomy (PPV), posterior capsulotomy, IOL, and capsular bag removal. Multiple intravitreal injections were required due to recurrence of infections after initial improvement with voriconazole injections.
Structural integrity was maintained and infection-free status was achieved in all the eyes. The presenting vision ranged from 6/60 to PL (perception of light). Seven out of 10 had improvement in their final vision over the presenting vision. Final outcome of four patients had vision of 6/24 or better, 4 patients had vision in the range of 2/60 to 6/36 and 2 patients had PL.
Trichosporon can cause devasting infections even in the immunocompetent, especially in association with implants and catheters. Triazoles form the mainstay of treatment of Trichosporon infection due to the high susceptibility of the organism in vitro. A regimen including voriconazole and amphotericin B may prove to be the most effective. This is the first report of an outbreak of cluster endophthalmitis caused by Trichosporon.
本研究旨在介绍一组由多药耐药真菌——毛孢子菌引起的群发性眼内炎的症状、体征、处理方法和结果。
这是一项回顾性、非随机、连续干预性病例系列研究。3 名外科医生在连续 3 天的手术中对 10 例术后眼内炎患者进行了手术，这些患者均在术后 3-5 个月出现眼内炎。所有病例均经微生物学证实。病原体对包括两性霉素 B 在内的大多数抗真菌药物均有耐药性。潜伏期约为 45 天。眼内炎的治疗包括玻璃体内注射、前房冲洗、经睫状体平坦部玻璃体切除术（PPV）、后囊切开术、人工晶状体（IOL）和囊袋内取出术。由于在初始使用伏立康唑注射治疗后感染复发，因此需要多次玻璃体内注射。
所有患者的眼内结构完整性均得以维持，感染得到控制。最初的视力改善后，仍有感染复发，最终视力为 6/60 至 PL（光感）。10 例患者中有 7 例最终视力较初始视力有所提高。4 例患者的最终视力为 6/24 或更好，4 例患者的视力在 2/60 至 6/36 之间，2 例患者为 PL。
即使在免疫功能正常的患者中，毛孢子菌也可能引起严重感染，尤其是与植入物和导管相关时。由于体外试验中该病原体对三唑类药物高度敏感，三唑类药物成为毛孢子菌感染治疗的主要药物。包括伏立康唑和两性霉素 B 的方案可能被证明是最有效的。这是首例由毛孢子菌引起的群发性眼内炎暴发的报告。
