eMedicine Specialties > Ophthalmology > Infectious Disease

Endophthalmitis, Fungal: Follow-up

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica; Rafael Alberto García, MD, Chief of Outpatient Services, Department of Ophthalmology, Hospital México of San José, Costa Rica
Contributor Information and Disclosures

Updated: Jul 24, 2007

Follow-up

Further Inpatient Care

  • Many patients with this condition are hospitalized. Patients may require intravenous medications.

Further Outpatient Care

  • Patients should receive follow-up care as needed.

Deterrence/Prevention

  • Once a positive fungal culture is obtained, the patient should be started on systemic antifungals. At the same time, an ophthalmologic consultation should be obtained. In 2 different studies using this protocol, the incidence of endogenous fungal endophthalmitis was reported to be only 3-9%.

Complications

  • Choroidal neovascularization at the site of chorioretinal scars
  • Epiretinal membranes
  • Tractional retinal detachment

Prognosis

  • The prognosis following fungal endophthalmitis depends on the virulence of the organism, the extent of intraocular involvement, and the timing and mode of interventions.

Miscellaneous

Medicolegal Pitfalls

  • Early recognition is important for preservation of vision.
 


More on Endophthalmitis, Fungal

Overview: Endophthalmitis, Fungal
Differential Diagnoses & Workup: Endophthalmitis, Fungal
Treatment & Medication: Endophthalmitis, Fungal
Follow-up: Endophthalmitis, Fungal
References
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References

  1. Akler ME, Vellend H, McNeely DM, Walmsley SL, Gold WL. Use of fluconazole in the treatment of candidal endophthalmitis. Clin Infect Dis. Mar 1995;20(3):657-64. [Medline].

  2. Anand A, Madhavan H, Neelam V, Lily T. Use of polymerase chain reaction in the diagnosis of fungal endophthalmitis. Ophthalmology. Feb 2001;108(2):326-30. [Medline].

  3. Blumenkranz MS, Stevens DA. Therapy of endogenous fungal endophthalmitis: miconazole or amphotericin B for coccidioidal and candidal infection. Arch Ophthalmol. Jul 1980;98(7):1216-20. [Medline].

  4. Breit SM, Hariprasad SM, Mieler WF et al. Management of endogenous fungal endophthalmitis with voriconazole and caspofungin. Am J Ophthalmol. Jan 2005;139(1):135-40. [Medline].

  5. Brod RD, Flynn HW, Clarkson JG, Pflugfelder SC, Culbertson WW, Miller D. Endogenous Candida endophthalmitis. Management without intravenous amphotericin B. Ophthalmology. May 1990;97(5):666-72; disc: 672-4. [Medline].

  6. Brooks RG. Prospective study of Candida endophthalmitis in hospitalized patients with candidemia. Arch Intern Med. Oct 1989;149(10):2226-8. [Medline].

  7. Christmas NJ, Smiddy WE. Vitrectomy and systemic fluconazole for treatment of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. Dec 1996;27(12):1012-8. [Medline].

  8. Cornely OA, Schmitz K, Aisenbrey S. The first echinocandin: caspofungin. Mycoses. 2002;45 Suppl 3:56-60. [Medline].

  9. Crump JR, Elner SG, Elner VM, Kauffman CA. Cryptococcal endophthalmitis: case report and review. Clin Infect Dis. May 1992;14(5):1069-73. [Medline].

  10. Donahue SP, Greven CM, Zuravleff JJ, Eller AW, Nguyen MH, Peacock JE Jr, et al. Intraocular candidiasis in patients with candidemia. Clinical implications derived from a prospective multicenter study. Ophthalmology. Jul 1994;101(7):1302-9. [Medline].

  11. Edwards JE Jr, Foos RY, Montgomerie JZ, Guze LB. Ocular manifestations of Candida septicemia: review of seventy-six cases of hematogenous Candida endophthalmitis. Medicine (Baltimore). Jan 1974;53(1):47-75. [Medline].

  12. Essman TF, Flynn HW Jr, Smiddy WE, et al. Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. Ophthalmic Surg Lasers. Mar 1997;28(3):185-94. [Medline].

  13. Gao H, Pennesi ME, Shah K, Qiao X, Hariprasad SM, Mieler WF, et al. Intravitreal voriconazole: an electroretinographic and histopathologic study. Arch Ophthalmol. Nov 2004;122(11):1687-92. [Medline].

  14. Griffin JR, Pettit TH, Fishman LS, Foos RY. Blood-borne Candida endophthalmitis. A clinical and pathologic study of 21 cases. Arch Ophthalmol. Jun 1973;89(6):450-6. [Medline].

  15. Gross JG. Endogenous Aspergillus-induced endophthalmitis. Successful treatment without systemic antifungal medication. Retina. 1992;12(4):341-5. [Medline].

  16. Henderson DK, Edwards JE Jr, Montgomerie JZ. Hematogenous candida endophthalmitis in patients receiving parenteral hyperalimentation fluids. J Infect Dis. May 1981;143(5):655-61. [Medline].

  17. Hunt KE, Glasgow BJ. Aspergillus endophthalmitis. An unrecognized endemic disease in orthotopic liver transplantation. Ophthalmology. May 1996;103(5):757-67. [Medline].

  18. Luttrull JK, Wan WL, Kubak BM, Smith MD, Oster HA. Treatment of ocular fungal infections with oral fluconazole. Am J Ophthalmol. Apr 1995;119(4):477-81. [Medline].

  19. Martinez-Vazquez C, Fernandez-Ulloa J, Bordón J, Sopena B, de la Fuente J, Ocampo A, et al. Candida albicans endophthalmitis in brown heroin addicts: response to early vitrectomy preceded and followed by antifungal therapy. Clin Infect Dis. Nov 1998;27(5):1130-3. [Medline].

  20. McDonald HR, De Bustros S, Sipperley JO. Vitrectomy for epiretinal membrane with Candida chorioretinitis. Ophthalmology. Apr 1990;97(4):466-9. [Medline].

  21. Naoi N, Sawada A. Effect of vitrectomy on epiretinal membranes after endogenous fungal endophthalmitis. Jpn J Ophthalmol. 1996;40(3):434-8. [Medline].

  22. Okhravi N, Adamson P, Mant R, Matheson MM, Midgley G, Towler HM, et al. Polymerase chain reaction and restriction fragment length polymorphism mediated detection and speciation of Candida spp causing intraocular infection. Invest Ophthalmol Vis Sci. May 1998;39(6):859-66. [Medline].

  23. Okhravi N, Dart JK, Towler HM, Lightman S. Paecilomyces lilacinus endophthalmitis with secondary keratitis: a case report and literature review. Arch Ophthalmol. Oct 1997;115(10):1320-4. [Medline].

  24. Ozdamar A, Aras C, Ozturk R, Akin E, Karacorlu M, Ercikan C. In vitro antimicrobial activity of silicone oil against endophthalmitis-causing agents. Retina. 1999;19(2):122-6. [Medline].

  25. Parke DW 2nd, Jones DB, Gentry LO. Endogenous endophthalmitis among patients with candidemia. Ophthalmology. Jul 1982;89(7):789-96. [Medline].

  26. Scherer WJ, Lee K. Implications of early systemic therapy on the incidence of endogenous fungal endophthalmitis. Ophthalmology. Oct 1997;104(10):1593-8. [Medline].

  27. Schiedler V, Scott IU, Flynn HW, Davis JL, Benz MS, Miller D. Culture-proven endogenous endophthalmitis: clinical features and visual acuity outcomes. Am J Ophthalmol. Apr 2004;137(4):725-31. [Medline].

  28. Sheu SJ, Chen YC, Kuo NW, et al. Endogenous cryptococcal endophthalmitis. Ophthalmology. Feb 1998;105(2):377-81. [Medline].

  29. Smiddy WE. Treatment outcomes of endogenous fungal endophthalmitis. Curr Opin Ophthalmol. Jun 1998;9(3):66-70. [Medline].

  30. Smith SR, Kroll AJ, Lou PL, Ryan EA. Endogenous bacterial and fungal endophthalmitis. Int Ophthalmol Clin. 2007;47(2):173-83. [Medline].

  31. Weishaar PD, Flynn HW, Murray TG, Davis JL, Barr CC, Gross JG, et al. Endogenous Aspergillus endophthalmitis: clinical features and treatment outcomes. Ophthalmology. Jan 1998;105(1):57-65. [Medline].

  32. Weissgold DJ, Maguire AM, Brucker AJ. Management of postoperative acremonium endophthalmitis. Ophthalmology. May 1996;103(5):749-56. [Medline].

  33. Zakka KA, Foos RY, Brown WJ. Intraocular coccidioidomycosis. Surv Ophthalmol. Mar-Apr 1978;22(5):313-21. [Medline].

  34. Zhang YQ, Wang WJ. Treatment outcomes after pars plana vitrectomy for endogenous endophthalmitis. Retina. Sep 2005;25(6):746-50. [Medline].

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Further Reading

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Keywords

fungal endophthalmitis, fungi, fungal infection, intraocular inflammation, intraocular surgery, eye trauma, vitreous, anterior chamber, candidal endophthalmitis, Candida endophthalmitis, Candida albicans, C albicans, Aspergillus endophthalmitis, Coccidioides endophthalmitis, Cryptococcus endophthalmitis, Blastomyces, Sporothrix, Paecilomyces, Acremonium, endogenous endophthalmitis, exogenous infections

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Contributor Information and Disclosures

Author

Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Rafael Alberto García, MD, Chief of Outpatient Services, Department of Ophthalmology, Hospital México of San José, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

Andrew A Dahl, MD, Residency Director, Ophthalmology, Kingston Hospital, Department of Ophthalmology, Assistant Professor of Surgery (Ophthalmology), Mid Hudson Family Practice Institute
Andrew A Dahl, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

R Christopher Walton, MD, Director of Uveitis and Ocular Inflammatory Diseases Service, Associate Professor, Department of Ophthalmology, University of Tennessee College of Medicine
R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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