FUNGAL ENDOPHTHALMITIS
Fungal endophthalmitis is most often associated with trauma or is from an endogenous source. Postoperative epidemics from
Candida parapsilosis[
13]
and
Paecilomyces lilacinus[
14] were caused by contaminated irrigating solutions. An excellent review of endogenous fungal endophthalmitis has been published.[15]
CANDIDA
Candida endophthalmitis is the most common endogenous fungal infection of the choroid. By the time symptoms are noted, two thirds of patients have bilateral disease and over half have vitreous involvement.[
16] About one third of patients with candidemia develop ocular candidiasis.[
17][
18] Ocular candidemia and intraocular infection is associated with major surgery, bacterial sepsis, systemic antibiotic use, intravenous drug abuse, indwelling catheters, and debilitating illness.[
19][
20][
21][
22] Vitrectomy can be an excellent means of making the diagnosis.[
23] Intraocular washings demonstrate budding yeast with pseudohyphae associated with acute and chronic inflammation (Figure 8-8). The organism is easily identified with periodic acid-Schiff preparations (Figure 8-9).
ASPERGILLUS
Aspergillus endophthalmitis is usually endogenous and is associated with intravenous drug abuse, organ transplantation, and endocarditis.[
24][
25][
26][
27] The infection spreads presumably by hematogenous seeding with deposition in the choroids and retina and extends secondarily into the vitreous cavity. Vitrectomy specimens reveal septated hyphae, which branch at 45
° angles. Gomori methenamine silver stains will highlight the fungal elements (Figure 8-10).
FUSARIUM
Fusarium solani is one of the most common organisms identified in fungal keratitis.[28][
29] It is one of the nonpigmented filamentous fungi. It has a propensity to invade the cornea, penetrate Descemet’s membrane, and involve the anterior and posterior chambers.[30] In the course of diagnosis, cytologic specimens, including corneal scraping, anterior chamber aspirates, and intraocular washings, may be obtained. Silver staining reveals septated hyphal forms that are difficult to differentiate morphologically from
Aspergillus (Figure 8-11).
References:
13.
Stern WH, Tamura E, Jacobs RA, Pons VG, Sone RD, et al. .Ophthalmology 1985;92:1701-1709.
14.
Pettit TH, Olson RJ, Foos RY, Martin WJ. . Arch Ophthalmol 1980;98:1025-1039.
15. Holland GN. Endogenous fungal infections of the retina and choroid. St. Louis: C.V. Mosby, 1989;2:625-636.
16.
Edwards JE Jr, Foos RY, Montgomerie JZ, Guze LB. Medicine 1974;53:47-75. 17.
Parke DWII, Jones DB, Gentry LO. Ophthalmology 1982;89:789-796.
18.
Griffin JR, Petit TH, Fishman LS, Foos RY. Arch Ophthalmol 1973;89:450-456.
19.
Graham E, Chignell AH, Eykyn S. J Infect 1986;89:388-395. 20.
Palmer Ea. Am J Ophthalmol 1980;89:388-395.
21.
Montgomerie JZ, Edwards JE Jr. J Infect Dis 1978;137:197-201.
22.
Servant JB, Dutton GN, Ong-Tone L, Barrie T, Davey C. Trans Ophthalmol Soc UK 1985;104:297-308. 23.
Snip RC, Michels RG. J Ophthalmol 1976;82:699-704.
24.
Demicco DD, Reichman RC, Violette EJ, Winn WC Jr. Cancer 1984;53:1995-2001.
25.
Doft BH, Clarkson JG, Rebell G, Forster RK. Arch Ophthalmol 1980;98:859-862.
26.
Naidoff MA, Green WR. Am J Ophthalmol 1975;502-509.
27.
Roney P, Barr CC, Chun CH, Raff MJ. Rev Infect Dis 1986;8:955-958.
28. Forster RK. Fungal diseases. Boston: little, Brown 1983;168-177.
29.
Liesegang TJ, Forster RK. Am J ophthalmol 1980;90:38-47.
30. Liesegang TJ. Bacterial and fungal keratitis. New York: Churchill Livingstone 1988;248-270.
