Successful treatment of fungal endophthalmitis using intravitreal
            caspofungin

Danielescu, Ciprian; Cantemir, Alina; Chiseliţă, D

doi:10.5935/0004-2749.20170048

Cited by 16 publications

(12 citation statements)

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“…While endogenous endophthalmitis is acquired hematogenously, the latter occurs due to ocular trauma or post-surgical complications [ 13 ]. In general, molds such as Aspergillus have been reported as one of the most common infectious agents for exogenous endophthalmitis [ 14 ], usually due to trauma and varying types of intraocular surgery [ 13 , 15 , 16 , 17 , 18 , 19 , 20 ]. Kernt et al reported that 90% of the post-operative endophthalmitis cases occur after cataract surgery [ 9 ], in addition to an increased risk for Aspergillosis in post-cardiac surgery and organ transplantation patients [ 16 ].…”

Section: Epidemiologymentioning

confidence: 99%

Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Khambati

Wright

Das

et al. 2022

JoF

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Fungal endophthalmitis is one of the leading causes of vision loss worldwide. Post-operative and traumatic injuries are major contributing factors resulting in ocular fungal infections in healthy and, more importantly, immunocompromised individuals. Among the fungal pathogens, the Aspergillus species, Aspergillus fumigatus, continues to be more prevalent in fungal endophthalmitis patients. However, due to overlapping clinical symptoms with other endophthalmitis etiology, fungal endophthalmitis pose a challenge in its diagnosis and treatment. Hence, it is critical to understand its pathobiology to develop and deploy proper therapeutic interventions for combating Aspergillus infections. This review highlights the different modes of Aspergillus transmission and the host immune response during endophthalmitis. Additionally, we discuss recent advancements in the diagnosis of fungal endophthalmitis. Finally, we comprehensively summarize various antifungal regimens and surgical options for the treatment of Aspergillus endophthalmitis.

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Section: Epidemiologymentioning

confidence: 99%

Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Khambati

Wright

Das

et al. 2022

JoF

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“…In a small case series of Candida endophthalmitis, intravitreal voriconazole (on average, four injections) was associated with a favourable clinical outcome [ 52 ]. Newer echinocandin antifungals may be effective against Candida resistant to azoles [ 1 , 53 ].…”

Section: Medical Treatmentmentioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

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“…Such an acute event probably determined the patients to confront their apprehension about coming to a hospital during a lockdown period. Postoperative complications of cataract surgery are also suscepti-ble to be rapidly diagnosed and emergency therapy is of utmost importance (13,14,15,16,17,18). Special interdisciplinary procedures helped reduce the length of hospital stay (18).…”

Section: Discussionmentioning

confidence: 99%

Ophthalmic pathology treated during Covid-19 at the Ophthalmology Clinic of “Sf. Spiridon” County Clinical Emergency Hospital in Iaşi, Romania

Bogdănici

2021

MSJ

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Within the current epidemiological context and due to the increased risk of infectivity, this article focuses on the practical activity of "Sf. Spiridon" Ophthalmology Clinic in Iaşi, during the emergency period (March 16 th -May 16 th , 2020), the evaluated ocular pathology and the approached strategy from the point of view of med ical and surgical vision. Material and methods: As an Emergency Hospital and Tertiary Center of Moldova, Romania "Sf. Spiridon" Hospital in Iaşi was the only hospital in the region that dealt with all the urgent ophthalmological pathology during COVID-19. The clinic worked due to the established protocol, the patient's circuit was changed, with the buffer zone for the suspicious COVID-19 patient, where the patient was hospitalized until the negative PCR result. All patients having a negative PCR test benefited from both medical and / or surgical treatment depending on the type of ocular pathology. Results: 619 patients were examined in the emergency room, of which 61 patients were hospitalized in Clinic I Ophthalmology, "Sf. Spiridon" Hospital in Iaşi, between March 16 and May 16, 2020. Most patients (59%) came from the neighboring counties (Suceava, Vaslui, Piatra Neamţ, Bacău) the rest being from Iaşi (41%). The age varied from 2 to 87 years, the average age being 51.72 ± 22.16. Most frequently, patients were hospitalized with retinal detachment (29.5%), trauma (24.6%) and corneal sclerosis (13.1%), most cases being surgical. The average length of stay was 6.3 days. The average time of surgery stages was 45 minutes. The condition at discharge was in 60% of cases improved and 30% cured. All patients tested negative for COVID-19 PCR. Visual acuity and IOP showed slightly higher / lower changes at discharge than a t the time of admission. Depending on the diagnosis, the average stay for the patients with retinal detachment was about 4 days, while for patients with glaucoma (13 days) or ulcer corneal (12 days), the long-term hospitalization exceeded 12 days. The multivariate analysis showed that about 10% of the number of days spent in hospital (dependent variable) can be e xplained by the diagnosis of hospitalization and the type of intervention. Correlated with the status of discharge, the number of days spent in hospital did not differ significantly. Conclusions: Most of the ophthalmological activity during the pandemic was surgical, due to the large number of trauma cases from neighboring counties, being the only non-COVID-19 hospital in the North-eastern region of Romania. Complying with the protocol suggested by

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Successful treatment of fungal endophthalmitis using intravitreal caspofungin

Cited by 16 publications

References 0 publications

Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Aspergillus Endophthalmitis: Epidemiology, Pathobiology, and Current Treatments

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Ophthalmic pathology treated during Covid-19 at the Ophthalmology Clinic of “Sf. Spiridon” County Clinical Emergency Hospital in Iaşi, Romania

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