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Objective To report the clinical features and treatment outcomes of 27 patients with fungal endophthalmitis (27 eyes)over a five year period.Methods The authors retrospectively reviewed the etiology,direct smear examination,fungal cul-ture and treatments of 27 patients with culture-proven fungal endophthalmitis at the affiliated Hospital of Medical College Qing-dao University from 2007 to 2012.Results Exogenous infection was defined in 21 patients (77.8%),including 20 associated with penetrating wound,and 1 following cataract surgery.Endogenous infection was found in 6 patients (22.2%),including 3 associated with recent use of high-dose steroids,1 after abortion,1 following pelvic fracture,and 1 with long-term use of im-munosuppressive agents.Fungal hyphae were found in 17 smears of 27 samples (63.0%)by direct microscopic examination. The fungal strains cultured from 27 samples belonged to 8 genus and 12 species.The most common isolates were Aspergillus , Fusarium and Candida species.A.flavus (22.2%)and A.fumigatus (18.5%)were the predominant Aspergillus species. F .moniliforme (14.8%)and F .oxysporum (11 .1 %)were the most predominant Fusarium species.Two eyes were eviscer-ated immediately due to the serious condition.Among the other 25 eyes,22 (88.0%)got improvement after at least one of such treatments as intravitreal injection of antifungal agent,vitrectomy or penetrating keratoplasty (PK).Conclusions Exoge-nous fungal endophthalmitis is the most common type of fungal endophthalmitis in this hospital.Penetrating wound is the main cause of such infections.Microscopic examination of hyphae and fungal culture were effective for the diagnosis of fungal endophthalmitis.Aspergillus is the predominant pathogens, followed by Fusarium.Intravitreal injection of antifungal a-gent combined with vitrectomy is an effective treatment of fungal endophthalmitis.
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Objective To analyze the distribution, diversity, and the sensitivity of common pathogen species to antifungal drugs in fungal keratitis during 2000 - 2006 in Shandong province. Methods Samples from corneal serapings and corneal buttons from keratoplasties were used for fungal culture and identification. The distribution and diversity of the pathogens in different years were analyzed. The sensitivity of some common species to antifungal drugs were tested. Results A total of 898 patients were diagnosed as fungal keratitis, in which 770 (85.7%) were positive in fungal culture. Pathogens in 748 cases caused by fungal infection were identified, of which 547 cases were caused by Fusarium (71.0%). The prevelence of Fusarium from 2000 to 2006 was 75.5%, 72.8%, 71.5%, 75.2%, 76%, 68. 8% and 56.4% respectively. Eighty-four cases were caused by Aspergillus( 10.9% ) , which accounted for 15.1% , 15.2% , 13.1%, 10. 2%, 10. 4% , 8.0% and 6. 9% of the cases from 2000 to 2006, respectively. Seventy-four eases were caused by Alternaria (9. 6% ), the percentage of which during 2000 -2006 was 1. 9%, 3.3%, 3.7%, 6. 6%, 8. 8%, 12. 0 and 29. 7% respectively. In genus Fusarium, 10 species were found and the most common species were Fusarium Solani ( 33. 8% ), Fusarium oxysporum ( 28.2% ) and Fusarium moniliforme( 27.4% ). Six species were identified in genus Aspergillus, with Aspergillus flavus (53.6%) and Aspergillus fumigatus (39.3% ) being the most common species. The geometric mean MICs of amphotericin B, terbinafin, itraconazole, 5-flucytosine and fluconazole against the common species were 0. 647, 0. 714, 1. 624, 15. 108 and 27. 070 μg/ml, respectively. The mean MICs of the above five antifungal drugs against Fusarium were 0. 899, 0. 893, 3.077, 37. 124 and 21. 687 μg/ml, respectively, and for Aspergillus, the mean MICs of these agents were 0.794, 0.591, 0.416, 23.973 and 7.127 μg/ml, respectively; for Alternaria,the MICs were 0. 409,0. 479,0. 433,11. 655 and 7. 104 μg/ml ,respectively. Conclusions Genus Fusarium, Aspergillus and Alternaria were the predominant pathogens in fungal keratitis in Shandong Province. During 2000 -2006, Fusarium was the most common one, followed by Aspergillus. The percentage of Aspergillus decreased annually. The third most common pathogen, Alternaria increased during the period. The geometric mean MICs of amphotericin B and terbinafin against Fusarium were lower than those of itraconazole, 5-flucytosine and fluconazole. The MICs of these five anti-fungal drugs against Aspergillus and Alternatia were lower than those for Fusarium.
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Objective To analyze the causes and pathogens of infectious endophthalmitis in ourhospital.Methods The clinical data and laboratory findings of 282 inpatients with infectiousendophthalmitis were retrospectively reviewed.There were 206 males(73.05%)and 76 females(26.95%)with a mean age of(36.0±11.2)years(range from 2 to 79 years).Except 14 patients who lost theireyeballs as of serious conditions.pathogen examinations of vitreous specimen had been performed for allremaining 268 cases.The clinieal and laboratory data were statistically analyzed by Chi-square and Kappaconsistency tests,when P<0.05 the difference should be considered as statistically significant.ResultsThe 4 major causes of infectious endophthalmitis of those 282 patients included ocular trauma(177cases,62.77%),infectious keratitis(61 cases,21.63%),eye surgery(32 cases,11.35%),andendogenous endophthalmitis(12 cases,4.25%).19.21% of the patients in ocular trauma group was 2-13years old,55.74% of the patients in infectious keratitis group was 14-50 years old,and 60.61% of thepatients in eye surgery group was 51-79 years old.The major pathogens were fungus and staphylococcieach accounted for 30.63% of all cases.Most of the pathogenic bacteria were sensitive to ciprofloxaein(81.81%)and gentamicin(77.92%).Conclusions The major reason of infectious endophthalmitis wasocular trauma,and the major pathogens were fungus and staphylococci.Those findings may help us totreat infectious endophthalmitis patients appropriately.
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OBJECTIVE To observe and compare the effects of conjunctival sac rinse of povidone iodine solution with sodium chloride solution.METHODS Eighty patients with senile cataract were randomly divided into 2 groups(group A and group B).Swab samples were taken for bacterial cultures from each patients of both groups before and 24 hours after application of 0.3% ofloxacin eye drops.Povidone iodine solution was used to rinse the conjunctival sac before cataract surgery in group A while 0.9% sodium chloride solution was used in group B,and swab samples were also taken for bacterial cultures.RESULTS Positive rates of the bacterial cultures before and after topical ofloxacin application were 58.8% and 27.5%,respectively.Positive rates of the bacterial cultures after conjunctival sac rinse with povidone iodine and sodium chloride were 5.0% and 20.0%,respectively.CONCLUSIONS Conjunctival sac rinse with povidone iodine solution should be taken as a routine procedure before intraocular surgery to decrease the risk of postoperative infections.