Analysis of predisposing clinical and laboratory findings for the development of endogenous fungal endophthalmitis. A retrospective 12-year study of 79 eyes of 46 patients.

PURPOSE: To analyze the predisposing factors for the development of endogenous fungal endophthalmitis (EFE) for its early diagnosis and treatment. SUBJECTS AND METHODS: Seventy-nine eyes of 46 patients with EFE treated in the 12-year period between 1986 and 1998 were included. A retrospective analysis was conducted in respect to age, sex, underlying disease, visual acuity, findings in the anterior and posterior segments, fungal culture of surgical specimens, fever of unknown origin, neutrophils < or = 500/mL, Cand-tec > or = x 4, beta-D-glucan > or = 20 pg, and final visual acuity. RESULTS: The patients were 34 men (74%) and 12 women (26%) between 18 and 78 years of age (mean 57.2 years). Thirty-three of the 46 patients (72%) also were diagnosed with cancer. Fungal infiltration limited to the retina (Stage I) was noted in 13%, budding in the vitreous cavity (Stage II) in 40%, vitreous opacity (Stage III) in 29%, and retinal detachment with Stage III (Stage IV) in 18% of 79 eyes with EFE. Forty patients (87%) were undergoing intravenous hyperalimentation (IVH). The mean interval between the start of IVH and the onset of disease was 11 days. Vitreous surgery was performed in 26 eyes (33%). Candida albicans was detected from surgical specimens in 38%. Fever of unknown origin was noted in 76%, neutrophils < or = 500/mL in 67%, Cand-tec > or = x 4 in 57%, and beta-D-glucan > or = 20 pg in 90% of subjects. CONCLUSION: In patients susceptible to opportunistic infection, beta-D-glucan > or = 20 pg (90%), IVH (87%), fever of unknown origin (76%), male sex (74%), the presence of cancer (72%), neutrophils < or = 500/mL (67%), and Cand-tec > or = x 4 (57%) were considered to be predisposing factors for the development of EFE.