Poster 1 Israel Gomez Sanchez

Methods:

We report the case of a 78 y.o. woman with arterial hypertension who developed a vitreous hemorrhage from a retinal broken macroaneurysm, that was treated with PPV.

Results:

After vitrectomy the Best Corrected Visual Acuity was 0.9 (Snellen Test). The patient discontinued treatment with postoperative topical antibiotics, without consulting. Two weeks later a corneal oedema and descemitis came up, without pain or vision loss. Five weeks later fungus endophthalmitis was evident with white, spherical, diffuse retinal deposits without vitritis. She underwent another PPV, vitreous washing and intravitreous and oral Voriconazol. That night she started with hallucinosis (rare adverse effect of Voriconazol; 1/100-1/10). Voriconazol was replaced by fluconazol p.o. and she was prescribed haloperidol. Immediately, after surgery, the colonies disappeared with clear media and good outcome. Eight months later a cystoid macular oedema was diagnosed with OCT and was treated with Ozurdex.

Conclusions:

The treatment of Candida albicans endophthalmitis with PPV was effective.

Discussion:

  1. Is it possible to diagnose of a ruptured aneurysm by ultrasound? We do not think that echography is accurate enough to detect a 1mm diameter dilatation of the artery. Had we performed an echography, focal retinal thickening would have been demonstrated?
  2. Which was the origin of the Candidiasis? Vaginal candidiasis, often referred to as a “yeast infection”, is a common problem, affecting nearly 75% of adult women in their lifetime. Our patient refused the idea of a culture of vaginal secretions.
  3. Could hallucinosis have been avoided? A review of publications says that the incidence of hallucinations is around 1-5%. Hallucinations associated with Voriconazol therapy can often be overlooked by physicians who focus on the patient’s serious illness and who do not inquire about what might be considered extraneous adverse events. Patients should be cautioned about the possibility of adverse events before starting Voriconazol therapy.
  4. Could macular oedema have been avoided? We think that both vitreous haemorrhage and endophthalmitis may have produced the macular edema.