Indian Journal of Medical Sciences Medknow Publications on behalf of Indian Journal of Medical Sciences Trust ISSN: 0019-5359 EISSN: 1998-3654 Vol. 63, Num. 8, 2009, pp. 366-367

Indian Journal of Medical Sciences, Vol. 63, No. 8, August, 2009, pp. 366-367

Letter To Editor

Aspergillus endophthalmitis : Pars plana vitrectomy is an alternative

Gonzalez-Granado LuisIgnacio

Department of Pediatrics, Hospital 12 Octubre

Correspondence Address:Av Andalucia km 5,400, 28041, Madrid

nachgonzalez@gmail.com

Code Number: ms09068

PMID: 19770530

DOI: 10.4103/0019-5359.55892

Sir,

I read with interest a case, reported by Hosseini et al.,^[1] of a 22-year-old man with allogenic orthotopic liver transplantation who suffered from Aspergillus endophthalmitis. The visual outcome of this patient was poor, despite prompt intravenous treatment with amphotericin, switched to intravenous voriconazole. I agree that in the past, Aspergillus endophthalmitis was associated with very poor visual outcome, ^[2] but I have some concerns about the medical management and absence of surgical treatment, which could have led to such poor visual outcome.

During the last few years, considerable effort has been made to recognize the main risks for an immunocompromised patient to suffer from fungal ocular infection. There have been some reports of successful outcome only with the addition of intravitreal amphotericin as an antifungal drug, ^[3],[4] but better outcome has been achieved with surgery in cases of fungal endophthalmitis. It consists of pars plana vitrectomy, ^[5] as has been recently reported in the largest series of cases published, in which 73% (16/22) recovered visual acuity of 'counting fingers' or better.

References

1.	Hosseini H, Saki S, Saki N, Eghtedari M. Aspergillus endophthalmitis in orthotopic liver transplantation. Indian J Med Sci 2009;63:253-6.  Back to cited text no. 1  [PUBMED]
2.	Schiedler V, Scott IU, Flynn HW Jr, Davis JL, Benz MS, Miller D. Culture-proven endogenous endophthalmitis: Clinical features and visual acuity outcomes. Am J Ophthalmol 2004;137:725-31.  Back to cited text no. 2
3.	Del Pozo JL, van de Beek D, Daly RC, Pulido JS, McGregor CG, Patel R. Incidence and clinical characteristics of ocular infections after heart transplantation: A retrospective cohort study. Clin Transplant 2009;23:484-9.  Back to cited text no. 3
4.	Bakri SJ, Sears JE, Procop GW, Shrestha R, Gordon SM. Excellent visual outcome following Aspergillus flavus endogenous endophthalmitis-farmer's lung disease. Int Ophthalmol 2009 [Available from http://www.springerlink.com/content/yn403562171p7p87/] .  Back to cited text no. 4
5.	Shen X, Xu G. Vitrectomy for endogenous fungal endophthalmitis. Ocul Immunol Inflamm 2009;17:148-52.  Back to cited text no. 5

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