Extreme Surgery in Endophthalmitis Caused by Fusarium


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ABSTRACT

Purpose:

To present the different evolution of two endophthalmitis caused by Fusarium solani, an aggressive filamentous fungus, depending on the medical and surgical treatment performed.

Setting:

Cornea and Retina Units, Ophthalmology Department, Virgin Macarena University Hospital (Seville, Spain). RETICS OftaRed, Institute of Health Carlos III (Madrid, Spain).

Methods:

We present two cases of endophthalmitis caused by Fusarium solani. Topical, intrastromal, intravitreal and systemic antifungal treatment (natamycin, voriconazole, amphotericin B) failed in both cases. Corneal perforation took place in one of them, being treated with cyanoacrylate and several amniotic membrane transplants, without success. Thus it was necessary to perform a hot penetrating keratoplasty (PK) in both patients. Lenses were removed and the microbiological analysis showed their colonization by Fusarium solani. In one of the cases, a second PK and a pars plana vitrectomy (PPV) were performed after corneal recurrence detected by confocal microscopy, as well as the following therapeutic intra and postoperative maneuvers: anterior chamber washing with povidone-iodine 5% during 1 minute; iridectomy of infiltrated regions; aspiration of fungal colonies with vitrector; several air/fluid/amphotericin/voriconazole exchanges during PPV; endodiathermy and endophotocoagulation of chor ioretinitis foci; intrascleral angle injections of voriconazole and amphotericin.

Results:

These were the only cases of endophtalmitis caused by Fusarium attended to at our hospital during the last 10 years. The case in which pars plana vitrectomy was not performed, rapidly recurred in a more aggressive way, so finally it was necessary to eviscerate the globe. On the other hand, the patient who underwent PPV with the specific surgical maneuvers and postoperative procedures described above, could preserve the eye and even a vision of hand motion without intraocular lens.

Conclusions:

The main objectives of these surgical procedures are to control the fungal infection and preserve the ocular globe. It is essential to eliminate all the ocular structures (iris, lens, vitreous, etcetera) affected by this strain of fungi in order to reduce the risk of reccurrence. When indicated, an early surgery with the appropriate maneuvers detailed above will avoid an evisceration, even recovering some visual acuity.


CONTACT DETAILS

Maria Isabel Relimpio Lopez
Sevilla, Spain
Email : irelimpio@gmail.com
Cell Phone: +34664249329
Work Phone: +34636248082