South Korean ophthalmologists reported a fungal endophthalmitis outbreak after cataract surgery resulting from contaminated viscoelastic material. The investigators, led by Seong Woo Kim, MD, PhD, from the Department of Ophthalmology, Korea University Guro Hospital, Seoul, Korea, found that prompt intervention may improve the prognosis associated with fungal endophthalmitis caused by polluted medical products. 1

Fungal endophthalmitis is rare, occurring in 0. 002% of cases in South Korea, according to the Korea Disease Control and Prevention Agency, but it generally follows an intractable clinical course with poor visual prognosis.

An “unusual” break out developed in October 2020, that became a nationwide outbreak and was discovered to be associated with contaminated viscoelastic materials (sodium hyaluronate).

Kim and colleagues conducted a retrospective case series analysis associated with clinical data from multiple institutions across the country from September 1, 2020, to October 31, 2021, to determine the epidemiologic and medical features plus treatment outcomes of this outbreak after cataract surgery.

The authors collected data from surveys carried out in May and October 2021 from your 100 members of the Korean Retinal Society.

Fungal endophthalmitis findings

The particular Korea Disease Control plus Prevention Agency confirmed that the viscoelastic agent was polluted.

A total of 265 patients (153 women, 57. 7%; 281 eyes; mean age, 65. 4 years) were diagnosed with yeast endophthalmitis. The diagnosis fungal endophthalmitis was made a mean of 24. 7 days after cataract surgery.

The particular clinical features of yeast endophthalmitis in the patients included vitreous opacity in 75. 4% associated with eyes, infiltration into the particular intraocular lens in 50. 9%, and ciliary infiltration in 19. 6%.

When cultures were performed within 260 of the 281eyes, and fungus was confirmed in 39. 6%, plus Fusarium species was identified in 86. 4%.

All patients had been treated along with intravitreal antibiotic and antifungal agents with/without pars plana vitrectomy. Whenever vitrectomy has been performed, intraocular lenses and lens capsules were removed based on surgeon preference. Postoperatively, all the patients received repeated intravitreal antifungal injections or liposomal amphotericin at least twice weekly, until the infection was considered to become under control. Systemic antifungals also were prescribed for those individuals whose contamination was not adequately controlled. Patients underwent another surgical treatment if the infection did not response adequately or even there was unresponsive inflammation right after the repeated intravitreal antifungal injection.

Following treatment, the mean best-corrected visual acuity improved through 0. 78 logarithm of the minimum angle of resolution (logMAR) (20/120 Snellen equivalent) to 0. 36 logMAR (Snellen equivalent, 20/45 at 6 months.

The researchers also documented that disease remission with no signs of fungal endophthalmitis (or cells in the particular anterior chamber milder than grade 1) occurred in 214 eyes (93. 9%).

They concluded, “The findings of the case series study support the potential benefit of prompt, aggressive surgical intervention that might reduce treatment burden plus improve prognosis of fungal endophthalmitis caused by contaminated medical items. ”

1. Kim SW, Betty JH, Choi M, et al. A good outbreak associated with fungal endophthalmitis after cataract surgery inside South Korea. JAMA Ophthalmol.   Published online January nineteen, 2023; doi: 10. 1001/jamaophthalmol. 2022. 5927

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