Dave VP, Pappuru RR, Pathengay A, Gupta R, Joseph J, Sharma S, Das T. Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes.
Asia Pac J Ophthalmol (Phila) 2020;
9:9-13. [PMID:
31990739 PMCID:
PMC7004472 DOI:
10.1097/01.apo.0000617928.43993.7e]
[Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE
The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis.
DESIGN
Retrospective, interventional, multicentric case series.
METHODS
The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed.
RESULTS
The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3-76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5-40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02).
CONCLUSIONS
Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.
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