Clinical Factors, Treatment Selection, and Outcomes in Postcataract Fungal Endophthalmitis from Contaminated Viscoelastics

초록

OBJECTIVE: To investigate the factors associated with treatment outcomes of postcataract surgery fungal endophthalmitis outbreaks related to contaminated viscoelastics. METHODS: Retrospective analysis of clinical data from multiple institutions. METHODS: This study included 228 eyes of 210 patients who were diagnosed with postcataract surgery fungal endophthalmitis related to the use of viscoelastic material (Unial, Unimed Pharmaceutical Inc); they were followed up for 6 months after the diagnosis. METHODS: Clinical features and causative species were identified and treatment outcomes were analyzed in patients who underwent 6 months of follow-up. Propensity score matching was conducted to elucidate the impact of vitrectomy timing and intraocular lens (IOL) removal on treatment outcomes. METHODS: Clinical factors and selection of treatment modalities associated with treatment outcomes at 6 months. RESULTS: Baseline visual acuity (P < 0.01), age (P&#xa0;= 0.05), and the presence of corneal edema (P < 0.01) were closely associated with poor best-corrected visual acuity (BCVA) at 6 months. Patients who underwent immediate vitrectomy after diagnosis showed significantly better BCVA at 6 months (mean logarithm of minimum angle of resolution 0.26 &#xb1; 0.43 vs. 0.52 &#xb1; 0.52, P&#xa0;= 0.03) and greater degree of visual improvement (mean&#xa0;-0.17 &#xb1; 0.37 improvement vs. 0.10 &#xb1; 0.57 deterioration, P&#xa0;= 0.03) than those who underwent deferred vitrectomy. Patients who underwent IOL removal during vitrectomy required a lower number of intravitreal antifungal agent injections (mean 8.9 &#xb1; 9.1 vs. 16.7 &#xb1; 12.2, P < 0.01) and showed a lower incidence of repeated vitrectomy (20% vs. 82%, P&#xa0;<&#xa0;0.01) than in those without IOL removal. CONCLUSIONS: In postcataract fungal endophthalmitis, prompt vitrectomy at the time of diagnosis resulted in better treatment outcomes, and IOL removal reduced the treatment burden. Prompt and aggressive surgical&#xa0;intervention should be considered for postcataract fungal endophthalmitis. BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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