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Management of postoperative fungal endophthalmitis with section infiltrates: Our experience

Aim: The aim of the study is to report the management of postoperative fungal endophthalmitis (POFE with corneoscleral infiltrates) after the cataract surgery. Settings and Design: The study was conducted at a tertiary care referral center in North Andhra. This was a retrospective, single-institution, interventional case series. Materials and Methods: Ten cases were microbiologically proven POFE, out of which eight cases having sclera-corneal infiltrates and two cases having corneal infiltrates, refractory to conventional management, were included in this study. Four cases were managed with intraocular lens (IOL) explantation, pars plana vitrectomy (PPV), intravitreal vancomycin, ceftazidime, and voriconazole, followed by the excision of corneoscleral infiltrate and therapeutic patch graft/therapeutic penetrating keratoplasty (TPK) as a secondary procedure. Six cases were managed with IOL explantation, excision of infected corneoscleral tissue, therapeutic corneoscleral patch graft/TPK, and anterior vitrectomy with intravitreal voriconazole. “Anatomical success” was defined as preserved anatomy of the globe and absence of signs of inflammation. “Functional success” was defined as an attached retina and a best-corrected visual acuity of better than 20/400. Results: Of the ten cases, the duration between cataract surgery and the diagnosis of endophthalmitis was 2–10 weeks in nine cases and 3 days in one case. Five cases were culture and potassium hydroxide (KOH) positive for fungus (Aspergillus fumigatus – 3, Aspergillus flavus – 1, and Aspergillus niger – 1), and five cases were KOH positive for fungus. No recurrences were observed after corneal patch graft/TPK with PPV and IOL explantation (Median follow-up – 12 months). Prestudy defined the criteria for successful “anatomical” and “functional” outcomes were achieved in 90% and 50%, respectively. Conclusion: This report highlights the effective role of combined IOL explantation, excision of infected tissue, therapeutic patch graft with PPV, and intravitreal voriconazole in managing POFE with corneoscleral infiltrates.