Author: Haytham Rezq
Co-authors: Bhaskar Gupta, Kashika Singh, Anthony Shinton, Saeed Kordo
Abstract
Purpose:
Management and outcomes of fungal endogenous endophthalmitis in five centres across the United Kingdom.
Setting/Venue:
University Hospital Southampton NHS Foundation Trust
Newcastle upon Tyne Hospitals NHS Foundation Trust
Southend University Hospital, Mid and South Essex NHS Foundation Trust
South Tyneside and Sunderland NHS Foundation Trust
Guy's and St Thomas' NHS Foundation Trust
Methods:
A retrospective observational multicentre study performed in 5 centres across the United Kingdom (UK). All patients with fungal endogenous endophthalmitis between 1st January 2014 and 31st December 2020 were identified using the Electronic Patient Record. A standardised spreadsheet was shared amongst the five centres to ensure consistent data collection. Data collected included patient demographics, systemic risk factors, ophthalmic clinical and surgical findings, ocular treatment, and systemic treatment. Data was collated and analysed at University Hospital Southampton.
Results:
Twenty-six patients diagnosed with fungal endogenous endophthalmitis were identified across the 5 participating centres during the 7-year study period. Eight patients were excluded due to insufficient recorded data, therefore 18 patients were included in the analysis. The mean age was 55.7 years (range 26 - 86 years), with male to female ratio 1:1 (9 male, 9 female). Hospital physician referrals accounted for 50%, ophthalmologist referrals for 40%, and the remainder were self-referrals. Regarding their systemic risk factors, 30% were hospitalised and 20% had a concurrent cancer diagnosis. Candida species were the main organism detected in peripheral blood cultures (83%). Ocular involvement was unilateral in 73% of cases. Two-thirds (67%) of cases presented with vitritis; only 11 % presented with hypopyon. Half of the patients had chorioretinitis, but only 16 % had macular-threatening chorioretinitis. Lesions took on average 14 weeks to resolve. The most common systemic antifungals used were voriconazole and fluconazole (44% each). Vitreous or sub-retinal biopsy and intravitreal anti-fungal injection were performed in 78%. Retinal detachment occurred in 28% as a complication of ocular treatment, and 73% of all cases underwent pars plana vitrectomy.
Conclusions
Fungal endogenous endophthalmitis remains rare, likely due to potent systemic antifungal agents and good intraocular penetration. Candida species remain the main causative organism across the UK. Unilateral vitritis is the commonest clinical presentation. There was a high rate of retinal detachment following intraocular intervention, and almost three-quarters of cases underwent vitrectomy surgery.
Financial Disclosure: No
