Study of ocular candidiasis during nine-year period.

BACKGROUND: To determine the clinical features, fungal profiles, treatment outcomes, and factors that are significantly associated with the visual outcomes of eyes with endogenous fungal endophthalmitis (EFE). MATERIAL AND METHODS: The medical records of 17 eyes of 9 patients diagnosed with EFE during January 2005 to December 2013 were reviewed. The collected data included patient characteristics, visual acuities (VAs), length between appearance of the first sign of infection and the first ophthalmic examinations, fungal profiles, and treatment regimen. The main outcome measure was the VA. Statistical analyses were done to detect the factors significantly associated with the visual prognosis. RESULTS: The median age at presentation was 67 years. Seven patients had Candida albicans, and 2 had Candida tropicalis. Eight patients received intravenous fosfluconazole, 4 systemic micafungin, 4 oral itraconazole, and 2 intravenous voriconazole. The minimum inhibitory concentrations of fluconazole against Candida albicans isolated from 5 patients ranged from 0.25 to 1.0 µg/mL. A final VA of ≥20/200 was achieved in 69.2% of the eyes. Multiple regression analysis (r(2) = 0.695) detected both initial logMAR (the Logarithm of the minimum angle of resolution) VA (P = 0.0067) and longer length between onset of symptoms and the first ophthalmic examinations (P = 0.0491) as significant worsen factors for final logMAR VA. CONCLUSIONS: Early ophthalmic consultation, better initial visual acuity, and use of effective systemic antifungal treatment might lead to relatively good visual outcomes in EFE.

The importance of initial management in the treatment of severe infectious corneal ulcers.

PURPOSE: To identify factors that influence the outcome of patients with severe infectious corneal ulcers. METHOD: A retrospective review was performed of the hospital records of all such patients admitted to the Doheny Eye Hospital during a 30 month period. Outcome variables examined were change in visual acuity, duration of hospitalization, hospital charges, and percentage of patients who required penetrating keratoplasty. RESULTS: Sixty-two ulcers were included. An organism was identified and antibiotic sensitivities established in 52 patients (84%). Inpatient therapy involved a combination of fortified aminoglycoside and cephalosporin antibiotics in 39 patients (63%) and was found to be appropriate on the basis of sensitivity studies in 49 (94%) of 52 patients. Inappropriate initial treatment was related to increased hospital charge (P = 0.024) as well as increased risk of penetrating keratoplasty (P = 0.001). CONCLUSIONS: Appropriate initial therapy is most critical in the course of serious corneal ulcers, and aggressive, broad-spectrum antibiotic coverage is advocated.