Video Presentation

Extreme surgical manoeuvres in fungal endophthalmitis

Video Details

First Author: M. I.Relimpio Lopez SPAIN

Co Author(s):    M. I. Reklimpio Lopez   M. Gessa Sorroche   A. M. Garrido Hermosilla   M. C. Diaz Ruiz   J. Montero Iruzubieta   J. Etxebarria Ecenarro              

Abstract Details



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. It was necessary to perform a hot penetrating keratoplasty (PK) in both patients. Lenses were removed and the microbiological analysis showed their colonization. In one of the cases, a second PK and a pars plana vitrectomy (PPV) were performed after corneal recurrence, 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 chorioretinitis 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.

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