Vitrectomy for Endogenous Fungal Endophthalmitis

Purpose: The purpose of this study was to evaluate the predisposing risk factors and treatment outcomes of endogenous fungal endophthalmitis (EFE). Methods: Records of 25 patients (29 eyes), diagnosed with EFE and treated at Shanghai Eye, Ear, Nose & Throat Hospital from January 2002 to December 2006, were retrospectively reviewed. Four patients had bilateral disease. Final visual acuity and recurrence of EFE were evaluated. Results: Of these 25 patients diagnosed with EFE, 20 patients (22 eyes) were treated by pars plana vitrectomy. Of the remaining 5 patients (7 eyes), 3 cases (4 eyes) were cured by antifungal drugs through systemic treatment and intravitreal injection, but another 2 cases (3 eyes) were only given intravitreal injection because of severe general conditions. Of the 22 eyes that underwent pars plana vitrectomy, 16 (73%) eyes gained visual acuity of counting fingers or better. Recurrent EFE was happened in 2 eyes. Vitrectomy was repeated in 1 eye, another was subsequently enucleated due to phthisis. Vitreous culture-proven or smear-proven EFE occurred in 27 or 2 eyes, respectively. Candida albicans occurred in 17 of 29 eyes (59%), and other causative organisms were yeast fungus (3 eyes), Aspergillus niger (3 eyes), Actinomyces (2 eyes),Aspergillus flavus (1 eye), and Fusarium (1 eye). Conclusion: Candida albicans were the most common causative organisms in EFE. The most common predisposing risk factors include recent major operation and intravenous administration in rural settings. Most patients with EFE will gain useful vision (counting fingers) after pars plana vitrectomy.