Fungal endophthalmitis: risk factors, diagnostics, prognosis
T. Neß1, A. Sander2
Purpose: Risk factors, rank of diagnostic procedures and prognosis of fungal endophthalmitis should be demonstrated.
Patients: Ten patients with suspected fungal endophthalmitis were inclu-ded. Samples from anterior chamber and/or vitreous body, taken between 1995 and 2000 were evaluated.
Results: Fungi were detected in 8 patients. Positive cultures of Candida species were obtained in six patients and of Aspergillus species in two. Detection from anterior chamber fluid succeeded in only one patient and from undiluted vitreous in 6 patients. In two patients positive culture results were obtained only after enrichment of vitrectomy fluid by ultracentrifugation and following cultivation. Serologic antibody or antigen tests were not helpful in any case. Risk factors of fungal infection were severe general disease (n=5), intravenous drug abuse (n=2), artifical heart valve (n=2), and prior cataract surgery (n=1). In all patients with candida infection visual function recovered with systemic and local antimycotic therapy. Despite intensive therapy the eyes with aspergillosis had to be enucleated.
Conclusion: Patients with reduced immune response have an increased risk of aquiring a fungal endophthalmitis. The most successfull method to detect fungi is ultracentrifugation of vitrectomy fluid followed by cultivation. Infection with candida species has a clearly better prognosis than infection with aspergillus species.
1Universitäts-Augenklinik Freiburg, Killianstrasse 5, D-79106 Freiburg