Título / Title

ENDOGENOUS FUNGAL ENDOPHTHALMITIS: A REPORT OF TWO CASES

Introdução / Purpose

We aim to discuss two cases of immunocompetent adults with different risk factors to endogenous fungal endophthalmitis (EFE) presenting with subacute chorioretinitis with distinct clinical courses and visual outcomes.

Material e Método / Methods

The cases report were elaborated from the analysis of medical records of two patients treated at two references hospitals in Belo Horizonte / MG.

Resultados / Results

Both patients presented with insidious visual loss, in one of them preceding by a therapy with intravenous analgesic medication and oral antibiotics for kidney stone disease and in the other one, associated with prolonged hospitalization secondary to a robot-assisted laparoscopic radical prostatectomy with complications. Fundus examination of both revealed multiple focal vitreous opacities with a string-of-pearls appearance and fluffy and white chorioretinal lesions. In face of high suspicion of EFE, diagnostic vitrectomy was performed, intravitreal injection of amphotericin B was made, and systemic fluconazole was prescribed. One patient achieves visual acuity of 20/200 in OD after treatment. The result of fresh slides analysis of vitreous samples was positive for yeast cells. The other one presented a positive blood culture for Candida Parapsilosis with a negative result for fungus in vitreous sample. Also, he evolved with retinal detachment and had undergone pars plana vitrectomy (PPV) with silicon oil implant achieving visual acuity of count fingers in OS.

Discussão e Conclusões / Conclusion

We report two patients with no history of previous intraocular surgery presenting with bilateral subacute chorioretinitis. Clinical features and risk factors of EFE prompted us to performed blood/ vitreous samples to culture and institute pharmacotherapy in both patients. Management is challenging and, although immediate intervention could contribute to better outcomes, visual prognosis may be poor.

Palavras Chave

endophthalmitis; endogenous fungal endophthalmitis; cases report

Area

CLINICAL RETINA