Successful treatment of fungal retinitis and retinal vasculitis with oral itraconazole

Traumatic endophthalmitis presenting as isolated retinal vasculitis and white-centered hemorrhages: Case report and review of literature

The article reports a case and review of the literature of endophthalmitis presenting as isolated retinal vasculitis. A 26-year-old male was observed to have white-centered retinal hemorrhages and retinal vasculitis following an occult scleral perforation. At presentation, the visual acuity was 20/60. With clinical suspicion of early endophthalmitis, he underwent wound exploration, scleral tear repair, vitreous biopsy and administration of intravitreal antibiotics. Microbiology evaluation revealed significant presence of methicillin-resistant coagulase-negative Staphylococcus epidermidis. Final visual acuity improved to 20/20 at 6 weeks postoperatively. Literature search revealed eight similar cases, all of them due to Staphylococcus species. Retinal vasculitis and white-centered retinal hemorrhages can be a presenting sign of early endophthalmitis, especially with non-fulminant pathogens like S. epidermidis.

Endogenous Candida endophthalmitis

Intraocular Candida infections, although uncommon, represent an important clinical problem owing to the potential for visual loss, which can be bilateral. Candida chorioretinitis and endophthalmitis are complications of systemic candidiasis with extension of the fungal pathogens to the uvea and retina. Early diagnosis and prompt management significantly affect the visual prognosis for these patients. This review evaluates the current literature on Candida endophthalmitis and includes discussion on presentation, diagnosis and management strategies. New systemic and intravitreal antifungal agents are also reviewed in the context of the management of intraocular fungal infection.

TREATMENT OUTCOMES AFTER PARS PLANA VITRECTOMY FOR ENDOGENOUS ENDOPHTHALMITIS

PURPOSE

To evaluate the causative organisms of and predisposing medical conditions in endogenous endophthalmitis and review visual acuity after pars plana vitrectomy.

METHODS

Records of 23 patients (32 eyes) who were diagnosed with endogenous endophthalmitis and treated at Shanghai Eye, Ear, Nose & Throat Hospital from January 2000 to December 2003 were retrospectively reviewed. Final visual acuity was followed up.

RESULTS

Of these 23 patients, 19 (86%) had endogenous endophthalmitis confirmed with a positive smear or culture; 12 cases (63%) were due to fungi, 6 (32%) were due to bacteria, and 1 (5%) was a mixed infection (fungus and bacteria). Culture specimens from four patients, which were obtained by vitrectomy, were all positive, while their initial vitreous needle biopsy specimens were negative. Of the 20 eyes that underwent pars plana vitrectomy, 17 (85%) had anatomical success, and 16 (80%) gained visual acuity of counting fingers or better; of these eyes, 8 (40%) had visual acuity of 20/200 or better.

CONCLUSION

Fungi, especially Candida albicans, were the most common causative organisms. The most common predisposing medical conditions were recent tumor surgery and intravenous administration in rural settings. Most patients with endogenous endophthalmitis who undergo pars plana vitrectomy will have useful vision (counting fingers). Vitreous specimens for culture that were obtained by vitrectomy were more sensitive in detecting the causative organism.