Five‐year retrospective review of guideline‐based management of fungal endophthalmitis

Abstract

ABSTRACT.Purpose: Guidelines were introduced in 2000 at the Bristol Eye Hospital (BEH) for the management of fungal endophthalmitis. A 5-year retrospective audit re-evaluated the guidelines and monitored the management of this rare condition. Clinical effectiveness and management costs were considered in light of visual outcome. Methods: Cases were identified through a 5-year retrospective review of theatre logbooks, Patient Administration System coded admissions with primary diagnosis of purulent endophthalmitis and pharmacy logbooks of patients receiving antifungal therapy. Data correlation and review of patient management were carried out in light of the findings. Results: Twenty-three cases were included, based on clinical disease and ⁄ or positive smears or cultures. Age range was 13-74 years, with a male : female ratio of 16 : 7 and right eye : left eye ratio of 14 : 9. Risk factors for fungal endophthalmitis included septicaemia caused by intravenous drug use (78%), presence of indwelling lines (9%), postocular surgery (9%) and post-trauma (4%). Guidelines were rigidly followed in 56% of cases, with improved visual acuity in 9 ⁄ 13 patients compared to 4 ⁄ 10 where management deviated from guidelines. Deviation from guidelines occurred with incomplete use of the recommended drug regimen for the disease severity or use of drugs that were alternative to the suggested guidelines. Treatment was initiated on clinical judgement in 91% of cases and laboratory diagnosis in 9%. Conclusion: The BEH guidelines provided a useful reference when managing this uncommon condition. Voriconazole, a newer broad-spectrum agent with good ocular penetration (used in 9%), has been added to the revised guidelines. Monitoring rare conditions over prolonged time frames supports evidencebased medicine.

Effect of formulation design and freeze-drying on properties of fluconazole multilamellar liposomes

“…Fungal infections of the cornea, especially Candida, are considered a major problem in ophthalmology because of diagnostic and therapeutic difficulties (Narendran et al, 2008). Candida was the most common cause of fungal endophthalmitis.…”

Liposomes as an ocular delivery system of fluconazole: in‐vitro studies

“…In a study carried out recently by Narendran et al (2008), Candida was the most common cause of fungal endophthalmitis. Fungal keratitis can impair vision or lead to total blindness.…”

The first case of endophthalmitis due to Rhinocladiella basitona in an immunocompetent patient

“…Intravitreal antifungal therapy combined with vitrectomy (Narendran et al, 2008) is recommended for management of FE. The in vitro susceptibility test is important for selection of sensitive antifungal agents, but currently, there are no CLSI interpretative criteria or guidelines for R. basitona by microbroth dilution.…”

“…Postocular operation (Chakrabarti et al, 2008) and trauma (Ramakrishnan et al, 2009) are the major etiologic factors of exogenous FE. For endogenous FE, however, the factors are various, such as abuse of intravenous drugs and extensive use of immunosuppressants and broad-spectrum antibiotics (Lingappan et al, 2012;Narendran et al, 2008;Zhang and Liu, 2010). The frequently encountered pathogens for endogenous FE, posttraumatic FE, and FE secondary to keratitis are Candida albicans, Aspergillus niger, and Fusarium solani, respectively (Essman et al, 1997;Sun et al, 2014;Wykoff et al, 2008;Zhang and Liu, 2010).…”