Vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in eastern China
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RESEARCH ARTICLE
Open Access
Vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in eastern China Hong Zhuang1,2, Xinyi Ding1,2, Ting Zhang1,2, Qing Chang1,2 and Gezhi Xu1,2*
Abstract Background: To evaluate the effect and prognostic factors of vitrectomy combined with intravitreal antifungal therapy for posttraumatic fungal endophthalmitis in Eastern China. Methods: We retrospectively reviewed the medical records of patients who developed fungal endophthalmitis after penetrating ocular trauma at an ophthalmic center in Eastern China. All patients underwent vitrectomy and intravitreal injection of antifungal drugs. Results: Thirty-five patients (35 eyes) were included. Twelve eyes suffered plant trauma, 17 eyes metal trauma, and 6 eyes other trauma. The culture results for all 35 eyes showed filamentous fungi, including Aspergillus in 26 eyes (74.3%). Twenty-three eyes underwent vitrectomy once and 12 eyes were treated twice. Four eyes were iridectomized because of a fungal lesion behind the iris. Fungal endophthalmitis was effectively controlled in 33 eyes (94.3%), whereas 2 eyes were ultimately enucleated. Visual acuity was significantly better after treatment than before treatment (P = 0.0006). According to the preoperative vision, the affected eyes were divided into two groups: group 1A (light perception) and group 1B (better than light perception). The final visual acuity in group 1B was significantly better than that in group 1A (P = 0.0289). Conclusions: Vitrectomy combined with intravitreal antifungal therapy is an effective treatment for posttraumatic fungal endophthalmitis. Preoperative visual acuity is a significant factor affecting the prognosis of visual acuity. Keywords: Fungal endophthalmitis, Penetrating ocular trauma, Vitrectomy, Antifungal therapy
Background Fungal endophthalmitis is a devastating infectious disease that can lead to serious visual impairment or even the loss of an eye. It can be divided into endogenous and exogenous endophthalmitis, which have completely different routes of infection. Endogenous fungal endophthalmitis is caused by the hematogenous spread of infectious microbes from distant foci and usually has systemic risk factors [1–3]. Exogenous fungal * Correspondence: [email protected] 1 Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China 2 Shanghai Key Laboratory of Visual Impairment and Restoration, and NHC Key Laboratory of Myopia (Fudan University), Shanghai 200031, China
endophthalmitis is caused by pathogens brought directly into the eye by an open eye injury or intraocular surgery [4], or is secondary to fungal keratitis [5]. The prevalence of posttraumatic fungal endophthalmitis varies in different countries. Fungal endophthalmitis after trauma predominantly occurs in developing countries, such as India and China [6–8], but it is rare in developed countries. A report from the USA retrospectively reviewed 41 cases of fungal endophthalmitis over 16 years, which incl
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