ABSTRACT
PURPOSE: Intraocular infection caused by Candida species can have devastating visual consequences. With the emergence of Candida as a major nosocomial pathogen, the authors investigated the prevalence of ocular lesions in patients with candidemia and evaluated risk factors for eye involvement. METHODS: This study is a prospective, multicentered, observational design. One hundred eighteen patients with candidemia were evaluated by the infectious disease service and received indirect ophthalmologic examination within 72 hours of a reported positive blood culture. Ocular findings were classified on the basis of objective, pre-determined criteria. Candida chorioretinitis was defined as the presence of focal, white, infiltrative chorioretinal lesions without vitreal involvement. Candida endophthalmitis was defined as chorioretinitis with extension into the vitreous or intravitreal "fluff balls." RESULTS: In contrast to previous studies of patients with candidemia citing prevalence rates of endophthalmitis approaching 40%, no patients were shown to have endophthalmitis. Candida chorioretinitis was seen in 9% of the patients, all of whom received antifungal agents. The observation that chorioretinitis never progressed to endophthalmitis suggests that systemic antifungal agents provided adequate ocular therapy. Risk factors for Candida chorioretinitis include fungemia with Candida albicans (versus nonalbicans species), multiple positive blood cultures, visual symptoms, and immunosuppression. Twenty percent of patients had nonspecific ocular lesions not directly related to infection. CONCLUSION: Patients with candidemia who have the risk factors noted above warrant formal ophthalmologic examination.
Subject(s)
Candidiasis/microbiology , Chorioretinitis/microbiology , Eye Infections, Fungal/microbiology , Fungemia/complications , Adolescent , Adult , Aged , Aged, 80 and over , Antifungal Agents/therapeutic use , Chorioretinitis/drug therapy , Chorioretinitis/pathology , Female , Fundus Oculi , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Retina/microbiology , Retina/pathology , Risk Factors , Visual AcuityABSTRACT
Three patients who had been treated with transscleral cryotherapy to the avascular retina for stage 3+ retinopathy of prematurity with threshold disease had total rhegmatogenous retinal detachments develop. In each case, the retinal detachment developed more than 1 year after treatment and resulted from a tear at the junction of the treated and untreated retina. Rhegmatogenous retinal detachment is a late complication of transscleral cryotherapy that to our knowledge has not previously been documented.