Outbreak of Fungal Endophthalmitis Due to Fusarium oxysporum Following Cataract Surgery

Abstract

Outbreak of exogenous Fusarium endophthalmitis after cataract surgery was evaluated. Twenty patients developed postoperative endophthalmitis. In 19 eyes, pars plana vitrectomy (PPV) was performed, in 14 cases (74 %) with primary intraocular lens explantation. In one case, the PPV was not performed because of poor general condition of the patient. Symptoms of endophthalmitis (damaged vision, iritis, tyndallization in anterior chamber, hypopyon) occurred at intervals of 16-79 days (mean 31.3 days). Fungal etiology was documented in 12 eyes (60 %). Fusarium oxysporum was evidenced by culture and/or microscopy and confirmed by PCR and sequencing analysis. Eighteen (90 %) patients were treated with oral voriconazole (400 mg/day) for a period of 4-6 weeks. The final visual acuity was 6/15 in 1 case (5 %), 6/60 and worse in 17 eyes (85 %), and in 2 cases (10 %), enucleation had to be performed. Viscoelastic filling material was suggested the most likely source of infection. Endophthalmitis caused by Fusarium spp. are a potentially big threat for patients with serious impact on vision. Successful management of the infection is highly dependent on early diagnosis including species identification and antifungal susceptibility testing, and on aggressive and long-term treatment.

Bacterial and Fungal Endophthalmitis

“…In a study from Australia of 98 patients undergoing cataract surgery, one patient developed postoperative Staphylococcus epidermidis endophthalmitis, and the isolate was identical to the patient's preoperative conjunctival isolate by pulsedfield gel electrophoresis (37). Occasionally a contaminated solution or material used during surgery is the source of pathogens, as in a recent outbreak of postoperative Fusarium oxysporum endophthalmitis following use of contaminated viscoelastic material (38).…”

Safety of Polyacrylamide 1.5% Left in Anterior Chamber in Combined Phacoemulsification and Pars Plana Vitrectomy Surgery

“…3 However, viscoelastic filling material was suggested the most likely source of endophthalmitis in a recent study. 19 In this study, short term iritis was seen in 2 patients and it disappeared quickly. None of the patients developed endophthalmitis during the 3 months follow-up period.…”

Fungi as causative agents of healthcare-associated infections

“…Prawdopodobną przyczyną było skażenie lepkosprężystego materiału wypełniającego, stosowanego podczas zabiegu. W efekcie większość pacjentów oprócz terapii worykonazolem przeszła także eksplantacje przeszczepianej rogówki, enukleację oka lub irydektomię [33].…”