Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes
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DOI：
10.1097/01.apo.0000617928.43993.7e
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发表时间：
2020-01-01
影响因子：
4.4
通讯作者：
Das, Taraprasad
中科院分区：
文献类型：
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作者：
Dave, Vivek Pravin;Pappuru, Rajeev R.;Das, Taraprasad
目的：本研究的目的是描述曲霉菌眼内炎的临床表现，管理和决定结果的因素。设计：回顾性，干预性，多中心病例series.Methods：本研究包括91例患者的91只眼，培养证实曲霉菌眼内炎。所有病例均提交前房液和/或玻璃体和/或人工透镜进行微生物评价。数据分析包括患者人口统计学、临床表现、干预措施和最终治疗结局。主要观察指标为最终视力和地球仪拯救度。结果：患者的平均年龄为39.71 ± 20.16岁（中位数40岁，范围3-76岁）。根据病因，眼内炎发生前的主要事件为外伤（42; 46.15%）眼、白内障手术（急性发作：30; 32.96%和延迟发作：6; 6.59%）眼、内源性（10; 10.98%）眼和角膜手术（3; 3.29%）眼。平均随访时间为5.78 +/- 6.74个月（中位数3，范围0.5-40个月）。良好视力预后的优势是视力>手部运动[优势比（OR）= 3.33，P = 0.02]，无角膜浸润（OR = 5.4，P = 0.03），玻璃体切除术代替单纯玻璃体穿刺（OR = 4.26，P = 0.03），玻璃体腔注射伏立康唑（OR = 3.63，P = 0.02），以及初次显微镜检查无真菌成分结论：曲霉菌性眼内炎早期行玻璃体切除联合玻璃体腔内注射伏立康唑可获得较好的解剖和功能恢复。五分之一的眼睛获得了良好的视力结果，三分之二的眼睛挽救了地球仪。
Purpose: The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis.Design: Retrospective, interventional, multicentric case series.Methods: The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed.Results: The mean age of the patients was 39.71 +/- 20.16 years (median 40 years, range 3-76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 +/- 6.74 months (median 3, range 0.5-40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02).Conclusions: Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.