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Surgical management of fungal endophthalmitis resulting from fungal keratitis

International Journal of Ophthalmology(English edition) 2016年第6期9卷 848-853页

作者： Yan Gao Nan Chen Xiao-Guang Dong Gong-Qiang Yuan Bin Yu Li-Xin Xie Qingdao University Medical College Qingdao 266071Shandong ProvinceChina Qingdao Eye Hospital Shandong Eye InstituteShandongAcademy of Medical SciencesQingdao 266071Shandong ProvinceChina Shandong Eye Hospital Shandong Eye InstituteShandongAcademy of Medical SciencesJinan 250021Shandong ProvinceChina

AIM： To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis （EFE） secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS： The clinical records of 27 patients （27 eyes） with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS： There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% （12/27） of the eyes, followed by Aspergillus in 22% （6/27）. Posterior segment infection was involved in 78% （21127） of the patients. The corneal infection was larger than 3 mmx3 mm in 89% （24/ 27） of the patients, and 22% （6/27） of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes （81.5%） underwent penetrating keratoplasty （PKP）, and over half of them （545%） were operated within 3d from the onset of antifungal therapy. Fourteen eyes （52%） underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes （55.6%） underwent pars plana vitrectomy （PPV）. The rate of the eyes undergoing PPV as the initial surgical procedure was 60% （9/15）, lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes （16/27）, and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes （18.5%） were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil ta

关键词： exogenous fungal endophthalmitis fungalkeratitis penetrating keratoplasty vitrectomy antifungaltherapy retinal detachment surgery

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