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  • Fungal Endophthalmitis After Cataract Surgery

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, March 2023

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    Kim et al. evaluated the features and outcomes of an outbreak of fungal en­dophthalmitis linked to a contaminated ophthalmic viscoelastic device (OVD) used in cataract surgery in South Korea. Based on their findings, they recommend performing vitrectomy in conjunction with IOL and lens capsule removal as a first-line treatment, especially when the causative agent is Fusarium species.

    The outbreak of fungal endophthal­mitis occurred between Sept. 1, 2020, and June 30, 2021. A contaminated OVD was withdrawn from the South Korean market. For this analysis, pa­tient data were collected from members of the Korean Retinal Society. Main outcomes were the clinical features and causative species in addition to treatment outcomes for patients who underwent six months of follow-up.

    A total of 310 eyes (282 patients) were reported by 100 retina specialists. Of these, 281 eyes (265 patients) were included in the study. The patients’ mean age was 65.4 ± 10.8 years, and 153 (57.7%) were female. The mean time between the cataract surgery and diagnosis was 24.7 ± 17.3 days.

    Initial clinical signs and symptoms included conjunctival injection (224 eyes; 79.7%), anterior chamber cell counts approximately 2+ or greater (253; 90%); fluffy or feathery infiltra­tion around the IOL periphery (143; 50.9%); and vitreous opacity (212; 75.4%). Cultures were performed in 260 (92.5%) of the eyes, and positive fungal culture results were noted in 103. The index species was Fusarium, which was detected in 89 (86.4%) of the culture-positive eyes; other fungal species included Aspergillus and Can­dida.

    As initial treatment, 68 eyes (29.8%) received injections of an intravitreal antifungal agent, 59 (25.9%) under­went vitrectomy without IOL removal, and 101 (44.3%) underwent vitrectomy with IOL removal. All told, 91 eyes underwent more than two vitrectomies, and 31 eyes were treated with intravit­real injections alone. Overall, a mean of 13 antifungal injections (range, 1-56) were administered; patients also received systemic antifungal therapy.

    With regard to treatment outcomes, mean BCVA improved from 20/120 at diagnosis to 20/45 at the six-month mark. Disease remission with no signs of fungal endophthalmitis was noted in 214 (93.9%) of the affected eyes.

    The original article can be found here.