Management of recurrent postoperative fungal endophthalmitis

AIM: To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy. SETTINGS AND DESIGN: Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series. MATERIALS AND METHODS: Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ‘Anatomical success’ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ‘Functional success’ was defined as an attached retina and a best corrected visual acuity of better than 20/400. RESULTS: Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re – PPV (median follow-up, 37 months). Pre-study defined criteria for successful ‘anatomical’ and ‘functional’ outcomes were achieved in 83.3% and 50% respectively. CONCLUSION: This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.