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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 METH...

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Autores principales: Vinekar, Anand, Dogra, Mangat R, Avadhani, Kavitha, Gupta, Vishali, Gupta, Amod, Chakrabarti, Arunaloke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005226/
https://www.ncbi.nlm.nih.gov/pubmed/24618484
http://dx.doi.org/10.4103/0301-4738.128588
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author Vinekar, Anand
Dogra, Mangat R
Avadhani, Kavitha
Gupta, Vishali
Gupta, Amod
Chakrabarti, Arunaloke
author_facet Vinekar, Anand
Dogra, Mangat R
Avadhani, Kavitha
Gupta, Vishali
Gupta, Amod
Chakrabarti, Arunaloke
author_sort Vinekar, Anand
collection PubMed
description 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.
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spelling pubmed-40052262014-05-01 Management of recurrent postoperative fungal endophthalmitis Vinekar, Anand Dogra, Mangat R Avadhani, Kavitha Gupta, Vishali Gupta, Amod Chakrabarti, Arunaloke Indian J Ophthalmol Original Article 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. Medknow Publications & Media Pvt Ltd 2014-02 /pmc/articles/PMC4005226/ /pubmed/24618484 http://dx.doi.org/10.4103/0301-4738.128588 Text en Copyright: © Indian Journal of Ophthalmology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Vinekar, Anand
Dogra, Mangat R
Avadhani, Kavitha
Gupta, Vishali
Gupta, Amod
Chakrabarti, Arunaloke
Management of recurrent postoperative fungal endophthalmitis
title Management of recurrent postoperative fungal endophthalmitis
title_full Management of recurrent postoperative fungal endophthalmitis
title_fullStr Management of recurrent postoperative fungal endophthalmitis
title_full_unstemmed Management of recurrent postoperative fungal endophthalmitis
title_short Management of recurrent postoperative fungal endophthalmitis
title_sort management of recurrent postoperative fungal endophthalmitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005226/
https://www.ncbi.nlm.nih.gov/pubmed/24618484
http://dx.doi.org/10.4103/0301-4738.128588
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