Fungal Endophthalmitis

Das, Taraprasad; Agarwal, Manisha; Anand, Appakkudal R.; Behera, Umesh Chandra; Bhende, Muna; Das, Anthony Vipin; DasGupta, Debarati; Dave, Vivek Pravin; Gandhi, Jaishree; Rameshkumar, Gunasekaran; Joseph, Joveeta; Kulkarni, Sucheta; Lalitha, Prajna; Mahendrakar, Priyanka A; Mitra, Sanchita; Mohamed, Ashik; Muralidhar, Alankrita; Nimeshika, Pillutla L; MTech, Gumpalli S Prashanthi; Sen, Alok; Sharma, Savitri; Uday, Prithviraj

doi:10.1016/j.oret.2021.09.006

Cited by 24 publications

(13 citation statements)

References 21 publications

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Section: Discussionsupporting

confidence: 49%

“…This case series study reported a nationwide outbreak of fungal endophthalmitis associated with contaminated viscoelastic material. Unlike previous studies wherein the source of infection was not officially identified, 5,6,[13][14][15] the source of infection and species were confirmed by an official government investigation in the present study, which highlights its validity. Reportedly, infection by various fungal species, including Aspergillus, Fusarium, and Candida species can cause fungal endophthalmitis associated with cataract surgery.…”

Section: Discussioncontrasting

confidence: 46%

“…Reportedly, infection by various fungal species, including Aspergillus, Fusarium, and Candida species can cause fungal endophthalmitis associated with cataract surgery. 5,6,9,13,15,16 The treatment outcomes were generally poor, with the final visual acuity deteriorating to 20/200 or worse in most patients, regardless of the causative species. 5,6,9,15,16 One notable finding is that the visual outcome in this study was generally favorable, with a mean BCVA of 0.36 logMAR (Snellen equivalent, 20/45) and only 8.8% of the patients exhibited a visual acuity worse than 20/200.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,9,13,15,16 The treatment outcomes were generally poor, with the final visual acuity deteriorating to 20/200 or worse in most patients, regardless of the causative species. 5,6,9,15,16 One notable finding is that the visual outcome in this study was generally favorable, with a mean BCVA of 0.36 logMAR (Snellen equivalent, 20/45) and only 8.8% of the patients exhibited a visual acuity worse than 20/200. There are several potential explanations for the favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea

Kim

Choi

et al. 2023

JAMA Ophthalmol

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ImportanceFungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis.ObjectiveTo report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea.Design, Setting, and ParticipantsThis was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022.Main Outcomes and MeasuresThe clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up.ResultsThe fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%).Conclusions and RelevanceThis was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.

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Section: Discussionsupporting

confidence: 49%

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea

Kim

Choi

et al. 2023

JAMA Ophthalmol

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Endogene Candida-Endophthalmitis

Huth,

Roth,

Viestenz

2024

Ophthalmologie

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ZusammenfassungDie endogene Candida-Endophthalmitis ist eine seltene, aber visusbedrohende Erkrankung. Eine durch Candida-Spezies hervorgerufene endogene Endophthalmitis hat in den meisten Fällen eine bessere Prognose als endogene Endophthalmitiden durch andere Pilzarten oder Bakterien, trotzdem ist die Prognose stark abhängig von der Zeitdauer bis zur Diagnostik und der anschließenden Therapie sowie dem initialen Visus. In der Vergangenheit wurden bereits Vorschläge für Therapiealgorithmen erstellt, verbindliche Leitlinien in der Ophthalmologie existieren aufgrund der Seltenheit der Erkrankung nur vereinzelt. In diesem Review soll auf die aktuellen Erkenntnisse zur endogenen Candida-Endophthalmitis eingegangen werden, und es werden Rückschlüsse aus der derzeitigen Studienlage gezogen.

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