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Postoperative candida parapsilosis endophthalmitis

Poster Details

First Author: P.Morales Lopez SPAIN

Co Author(s):    F. Chait   F. Spencer   S. Alforja   J. Giralt     

Abstract Details



Purpose:

To describe a case of successfully treated postoperative candida parapsilosis endophtalmitis following clears lens extraction.

Setting:

Retina and vitreous service in a tertiary hospital in Spain.

Methods:

Descriptive clinical case, fifteen-month follow-up and imaging examinations.

Results:

Forty-nine year old immunocompetent male, treated with clear lens extraction refractive surgery in both eyes in other centre. Five weeks after second eye (left eye, OS) surgery, signs of endopfthalmitis were evidenced during clinical examination. Initially treated with oral and intravitreal antibiotics and pars plana vitrectomy (PVV). No microorganisms were isolated on vitreous samples. Referred to our centre due to persistent signs of infection, five months after initial diagnosis. Another PVV (including intraocular lens (IOL)-capsule complex extraction) was performed. Cultures were positive to candida parapsilosis in vitreous and IOL-capsule complex, and treated with a unique intravitreal amphotericine B injection, oral fluconazole 600 mg/day and topical steroids. Because of persistent infiltrates in corneal endothelium, anterior chamber washout was performed and candida parapsilosis isolated in aqueous humour samples; hence topical voriconazole was added to antifungal treatment regimen of oral fluconazole. Three months after topical and oral antifungal treatment, infection remained inactive and antimicrobials were discontinued. Macular cystic oedema (CME) was evidenced by optical coherence tomography (OCT) and treated with oral acetazolamide and topical non-steroidal anti-inflammatories (NSAIDs). Resolution of CME and no signs of infection recurrence after 3 months of discontinued antifungal therapy. Final best-corrected visual acuity (BCVA) on the OS was 0.8.

Conclusions:

Candida parapsilosis endophtalmitis is a rare cause of postoperative infection, most oftenly attributed to contamination sprouts of solutions commonly used in ophthalmologic surgery. Clinically presents as an insidious low-grade infection and steroids (usually prescribed as postoperative anti-inflammatory agents) can delay diagnosis, hence its management. IOL-capsule complex extraction remains controversial in treatment of this infection; evidence in favour claims that candida colonies attached to the IOL-capsule complex and corneal endothelium embody nests, which may be responsible of recurrence and must be removed to complete resolution of infection. Azoles antifungal agents proof good safety profile and vitreous penetrance and are effective against candida species. Here we describe a case of post-operative candida parapsilosis endopthalmitis, successfully treated with PVV, IOL-capsule complex extraction and oral/topic azoles antifungal therapy. CME in this case seems multifactorial, mainly due to persistent inflammation and was successfully managed with oral osmotic agents and topical NSAIDs. Resolution of CME and no signs of clinical recurrence were seen after a three month-suspended antifungal treatment period and final follow-up. FINANCIAL INTEREST: NONE

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