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Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes

The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. DESIGN: Retrospective, interventional, multicentric case series. METHODS: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthal...

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Autores principales: Dave, Vivek Pravin, Pappuru, Rajeev R., Pathengay, Avinash, Gupta, Rajan, Joseph, Joveeta, Sharma, Savitri, Das, Taraprasad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004472/
https://www.ncbi.nlm.nih.gov/pubmed/31990739
http://dx.doi.org/10.1097/01.APO.0000617928.43993.7e
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author Dave, Vivek Pravin
Pappuru, Rajeev R.
Pathengay, Avinash
Gupta, Rajan
Joseph, Joveeta
Sharma, Savitri
Das, Taraprasad
author_facet Dave, Vivek Pravin
Pappuru, Rajeev R.
Pathengay, Avinash
Gupta, Rajan
Joseph, Joveeta
Sharma, Savitri
Das, Taraprasad
author_sort Dave, Vivek Pravin
collection PubMed
description The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. DESIGN: Retrospective, interventional, multicentric case series. METHODS: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed. RESULTS: The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3–76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5–40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02). CONCLUSIONS: Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.
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spelling pubmed-70044722020-02-19 Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes Dave, Vivek Pravin Pappuru, Rajeev R. Pathengay, Avinash Gupta, Rajan Joseph, Joveeta Sharma, Savitri Das, Taraprasad Asia Pac J Ophthalmol (Phila) Original Clinical Study The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. DESIGN: Retrospective, interventional, multicentric case series. METHODS: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed. RESULTS: The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3–76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5–40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02). CONCLUSIONS: Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes. Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong 2020-02-03 /pmc/articles/PMC7004472/ /pubmed/31990739 http://dx.doi.org/10.1097/01.APO.0000617928.43993.7e Text en Copyright © 2020 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle Original Clinical Study
Dave, Vivek Pravin
Pappuru, Rajeev R.
Pathengay, Avinash
Gupta, Rajan
Joseph, Joveeta
Sharma, Savitri
Das, Taraprasad
Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title_full Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title_fullStr Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title_full_unstemmed Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title_short Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
title_sort aspergillus endophthalmitis: clinical presentations and factors determining outcomes
topic Original Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004472/
https://www.ncbi.nlm.nih.gov/pubmed/31990739
http://dx.doi.org/10.1097/01.APO.0000617928.43993.7e
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