Department of TCM Ophthalmology, Hebei Eye Hospital, Hebei province, China.
Hebei Provincial Key Laboratory of Ophthalmology, Hebei province, China.
Medicine (Baltimore). 2023 Apr 21;102(16):e33585. doi: 10.1097/MD.0000000000033585.
Endogenous fungal endophthalmitis is a challenging condition. There are no universally accepted diagnostic or management protocols. We share a case of endogenous fungal endophthalmitis who was successfully treated, focusing on the diagnostic and treatment procedures.
A 31-year-old female with a history of fungal vaginitis and tinea corporis presented with progressive visual decrease in both eyes after having an induced abortion. Her best corrected visual acuity at presentation was 20/1000 in her right eye and 20/250 in her left eye. Upon slit lamp examination, mild inflammatory reaction in the anterior chamber was found. Dilated fundus examination revealed a hazy view of the optic disc and posterior retina, and there was a whitish mass with "string and pearls" just in front of the macular region in each eye.
Bilateral fungal endogenous endophthalmitis was diagnosed empirically, which was confirmed later by deoxyribonucleic acid sequencing and culture of intraocular fluid.
Oral itraconazole and intravitreal voriconazole were administered to the patient at first. The intraocular inflammation was partially responsive to the medication, yet the visual acuity persisted to deteriorate and the vitreous whitish masses became more prominent. Then vitrectomy procedures were carried out and oral itraconazle was switched to intravenous fluconazole. The antifungal treatment lasted for 8 weeks.
The intraocular inflammation alleviated and visual acuity improved after vitrectomy. At the 9-month follow-up visit, the patient's best corrected visual acuity was 20/40 in the right eye and 20/30 in the left eye. There was no intraocular inflammatary reaction, and retinal scar was noticed in each eye.
Early and correct diagnosis, coupled with prompt and aggressive treatment, is crucial for cases of fungal endogenous endophthalmitis. Deoxyribonucleic acid sequencing techniques can contribute to early diagnosis, while vitrectomy may be necessary when antifungal medication is insufficient in controlling the condition.
内源性真菌性眼内炎是一种具有挑战性的疾病。目前尚无普遍接受的诊断或治疗方案。我们报告了一例成功治疗的内源性真菌性眼内炎病例，重点介绍了诊断和治疗过程。
一名 31 岁女性，有真菌性阴道炎和体癣病史，在人工流产后出现双眼进行性视力下降。她就诊时最佳矫正视力右眼为 20/1000，左眼为 20/250。裂隙灯检查发现前房有轻度炎症反应。散瞳眼底检查发现视盘和后视网膜模糊，双眼黄斑区前均有一个灰白色肿块，呈“串珠状”。
根据经验诊断为双侧真菌性内源性眼内炎，后来通过眼内液脱氧核糖核酸测序和培养得到证实。
患者最初接受了口服伊曲康唑和玻璃体内伏立康唑治疗。眼内炎症对药物部分有反应，但视力持续下降，玻璃体灰白色肿块变得更加明显。随后进行了玻璃体切除术，并将口服伊曲康唑改为静脉注射氟康唑。抗真菌治疗持续了 8 周。
玻璃体切除术后眼内炎症减轻，视力提高。在 9 个月的随访中，患者右眼最佳矫正视力为 20/40，左眼为 20/30。眼内无炎症反应，每只眼均发现视网膜瘢痕。
早期正确的诊断，加上及时和积极的治疗，对内源性真菌性眼内炎病例至关重要。脱氧核糖核酸测序技术有助于早期诊断，而当抗真菌药物不足以控制病情时，玻璃体切除术可能是必要的。
