Cases reported "Eye Infections, Fungal"

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1/5. exophiala werneckii endophthalmitis following cartaract surgery in an immunocompetent individual.

    A case of infectious endophthalmitis caused by the saprophyte exophiala werneckii is reported. This has not been recognized as a pathogen for ocular infections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was that of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial management consisted of empirical intravitreal injection of vancomycin, ceftazidime, and amphotericin b. Treatment was supplemented with a 3-week course of systemic fluconazole and topical therapy with natamycin, atropine, ciprofloxacin, and diclofenac. The visual acuity returned to 20/20-2 with no recurrence of infection. The source of the infection could not be determined. Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultures are helpful for establishing the diagnosis early in the course of disease. E werneckii should be considered in the differential diagnosis of fungal endophthalmitis.
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ranking = 1
keywords = phacoemulsification
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2/5. Severe keratomycosis secondary to scedosporium apiospermum.

    PURPOSE: To report an unusual case of severe keratomycosis caused by scedosporium apiospermum without any known previous ocular injury, that resulted in a corneal perforation, which was treated with an emergency penetrating tectonic keratoplasty and later with phacoemulsification and astigmatic keratotomy to restore good visual function. methods: A 45-year-old woman with a history of multiple sclerosis presented with a severe and refractory corneal abscess in her right eye without any known prior injury. Corneal scrapings were obtained and stained for microscopic evaluation. The samples were sent for aerobic and anaerobic bacterial and fungal cultures. RESULTS: Microbiologic examination of the corneal scraping showed scedosporium apiospermum micelle. The fungal culture was sensitive to miconazole, itraconazole and voriconazole. Partial clinical improvement was achieved with hourly topical natamycin, amphotericin b, and systemic itraconazole application, although in vitro sensitivity tests showed resistance to the topical antifungal agents used. A corneal paracentral perforation occurred despite aggressive treatment. An emergency eccentric penetrating keratoplasty was performed with satisfactory results. Subsequent phacoemulsification and astigmatic keratotomy restored a good visual function. CONCLUSION: A fungal etiology should be suspected in a progressive and refractory corneal abscess. This report highlights the utility of microbiologic investigation to perform an early and accurate diagnosis. Aggressive medical treatment and even therapeutic penetrating keratoplasty to remove infected tissue could result in the maintenance of useful visual function. In view of the poor prognosis of this specific fungus, a closer observation and early keratoplasty might be required to preserve the ocular globe.
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ranking = 2
keywords = phacoemulsification
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3/5. aspergillus endophthalmitis after sutureless cataract surgery.

    PURPOSE: We studied a case of aspergillus endophthalmitis after sutureless cataract surgery. methods: A patient underwent sutureless phacoemulsification complicated by a posterior capsular tear. She subsequently developed aspergillus endophthalmitis. amphotericin b was injected intravitreally at the time of repeat pars plana vitrectomy. RESULTS: The eye was enucleated because of pain and poor response to treatment. CONCLUSIONS: We recommend suturing the wound in any eye that has experienced a complication of surgery.
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ranking = 1
keywords = phacoemulsification
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4/5. Pseudophakic candida parapsilosis endophthalmitis with a consecutive keratitis.

    We describe a case of candida parapsilosis endophthalmitis with a consecutive keratitis after phacoemulsification and posterior chamber intraocular lens implantation in an otherwise healthy eye. Despite aggressive medical and surgical management during a 2-year period, multiple episodes recurred, with the development of an intracapsular plaque and an infectious nidus on the corneal endothelium 6 months after the initial presentation. After subtotal removal of the culture-positive capsule, intravitreal and topical amphotericin b, and oral fluconazole, the inflammation improved. However, the corneal endothelial plaque persisted with recurrent inflammation 2 months later, prompting debridement of the culture-positive plaque and further removal of the culture-negative capsular remnants and lens implant. The infection was quiescent for the subsequent 12-month period until recurrent intraocular inflammation developed with enlargement of the endothelial plaque. culture of this plaque was again positive for C. parapsilosis. After debridement and intraocular and topical amphotericin b, the eye has now been quiescent for 13 months. This case demonstrates the development of a secondary keratitis in an eye affected by pseudophakic C. parapsilosis endophthalmitis, with the posterior cornea serving as a sanctuary site for the fungus despite aggressive management leading to recurrent infection 1 year after the clinical disease appeared to be quiescent.
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ranking = 1
keywords = phacoemulsification
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5/5. Management of postoperative acremonium endophthalmitis.

    PURPOSE: Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by acremonium kiliense with in vitro sensitivity to amphotericin b. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin b injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations. methods: The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin b, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients for management of either primary (1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens. RESULTS: Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin b. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin b injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin b. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms. CONCLUSIONS: Single-dose administration of intravitreous amphotericin b was inadequate treatment for fungal endophthalmitis caused by A. kiliense. vitrectomy with repeated intravitreous administration of amphotericin b may be necessary to eradicate intraocular function caused by this organism.
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ranking = 1
keywords = phacoemulsification
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