Delayed-onset Candida parapsilosis cornea tunnel infection and endophthalmitis after cataract surgery: Histopathology and clinical course

Abstract

PurposeTo describe a patient with late post-operative endophthalmitis and clear cornea tunnel infection caused by Candida parapsilosis that was masquerading as chronic anterior uveitis.ObservationsA 62-year old woman with history of uncomplicated cataract surgery 7 months prior and chronic postoperative anterior uveitis, presented with an endothelial plaque, hypopyon, and infiltrates in the capsular bag and within the clear corneal tunnel. Anterior chamber cultures identified C. parapsilosis and pathology of the endothelial plaque showed fungus. Anterior chamber washout, scraping of the endothelial plaque, serial intracameral and intravitreal injections with amphotericin B (10 mcg) failed to control the infection. Pars plana vitrectomy, removal of the intraocular lens and capsular bag, a corneal patch graft, and administration of intravitreal antifungal agents were performed. One year later the patient remains free of recurrence and her best-corrected vision is 20/25 with a rigid gas permeable contact lens.Conclusionsand Importance: Persistent intraocular and intracorneal inflammation after cataract surgery should raise suspicion of endophthalmitis caused by fungi non-responsive to topical and intravitreal antibiotics. Surgical intervention and removal of the nidus of infection, which is often the intraocular lens and capsular bag, may be necessary for a successful outcome.

Postoperative Fungal Keratitis Managed by Anterior Chamber Washout and Intracameral Amphotericin-B: A Report of Two Cases

“…Fungal corneal tunnel infections after phacoemulsification surgery are uncommon. Palioura et al reported that there are 23 cases have been published in the literature [ 3 ]. Twelve eyes (52.2%) advanced to endophthalmitis with poor visual outcomes (visual acuity ≤ 6/120) in three patients, and loss of the eye occurred in four patients, three of which became phthisis bulbi and one underwent evisceration of the eye [ 3 ].…”

“…Palioura et al reported that there are 23 cases have been published in the literature [ 3 ]. Twelve eyes (52.2%) advanced to endophthalmitis with poor visual outcomes (visual acuity ≤ 6/120) in three patients, and loss of the eye occurred in four patients, three of which became phthisis bulbi and one underwent evisceration of the eye [ 3 ]. The latency period between the date of cataract surgery and the presentation of the fungal tunnel infection varied from three days to 15 years with a median of one month [ 3 ].…”

“…Twelve eyes (52.2%) advanced to endophthalmitis with poor visual outcomes (visual acuity ≤ 6/120) in three patients, and loss of the eye occurred in four patients, three of which became phthisis bulbi and one underwent evisceration of the eye [ 3 ]. The latency period between the date of cataract surgery and the presentation of the fungal tunnel infection varied from three days to 15 years with a median of one month [ 3 ]. In this case report, the first patient had a latency period of nine months, and the second case had a latency period of six months prior to presentation.…”

“…the most common, followed by Candida spp., Fusarium spp., Alternaria spp., and Scedosporium spp. (only a few reported cases as of this writing) [ 3 ].…”

Fungal Endophthalmitis. Literature Review

“…Полостные хирургические вмешательства, в особенности при катаракте [42] и дренажной операции при глаукоме [41], также могут служить причиной развития грибкового эндофтальмита, однако процент их встречаемости крайне низкий и в основном связан с интраоперационном заносом бактериальных спор с инструментария, расходных материалов, рук персонала или кожных покровов пациента [38][39][40].…”