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First Author: M.Wilczynski POLAND
Co Author(s): O. Wilczynska W. Omulecki
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Endogenous endophthalmitis is a rare and severe intraocular infection which can be vision-threatening. The purpose is to describe a case of bilateral fungal endogenous endophthalmitis in a patient, who was successfully treated with systemic administration of fluconazole and pars plana vitrectomy with an intravitreous injection of amphotericin B.
Department of Ophthalmology, Medical University of Lodz, Poland.
A 64year old male was referred to the Department of Ophthalmology for decreased vision. The patient had had two surgeries: pancreatoduodenectomy as a treatment for carcinoma of distal part of the bile duct and right-sided hemicolectomy. After these operations, the patient had long-standing intravenous feeding and intensive general antibiotic therapy. Three weeks after the first operation, the patient noticed bilateral deterioration of vision. In both eyes juxtafoveal lesions were seen. Bilateral endogenous endophthalmitis was diagnosed. Intravenous Fluconazole 200 mg/day was administered, as well as 1% Tropicamide eyedrops. Symptoms of anterior uveitis resolved within 2 days. Fungal culture from a blood sample was performed 3 times, however, the results were negative. The patient underwent pars plana vitrectomy with intravitreous injection of amphotericin B in both eyes. Vitreous tap was taken during vitrectomy and samples of vitreous fluid were sent for cultures (bacteriologic and mycological) and direct specimens were made. Culture results turned out to be negative, direct specimens revealed presence of Candida Sp. The patient received fluconazole intravenously and orally for 3 months in total.
This treatment resulted in a marked increase in visual acuity, BCVA in the right eye = 0.5 and BCVA in the left eye = 0.3. After the active inflammatory reaction was controlled pharmacologically, retinal and choroidal scars were present in both eyes. In the left eye one of these scars was located in the upper part of the macula. One year after the initial diagnosis of endophthalmitis, the patients visual acuity amounted to BCVA in the right eye = 0.4 and BCVA in the left eye = 0.1.
The present case report demonstrates that intravenous and oral fluconazole combined with pars plana vitrectomy with an intravitreous injection of amphotericin B, is an effective treatment for endogenous fungal endophthalmitis. Direct specimens of the vitreous tap material should be made, as they allow to identify the causative pathogen even in case of negative culture results.