ABSTRACT
PURPOSE: To evaluate the visual outcomes following aggressive management of filamentous fungal endophthalmitis with prompt surgical intervention and oral and intravitreal voriconazole. METHODS: Retrospective chart review study of consecutive patients with culture- or biopsy-proven filamentous fungal endophthalmitis treated at an academic referral center. Clinical characteristics, treatment regimens, and visual outcomes were analyzed. RESULTS: Included were 5 patients, 1 with endogenous endophthalmitis due to systemic fusariosis and 4 due to exogenous endophthalmitis (1 with Fusarium, 2 with Scedosporium apiospermum, and 1 with Glomerella spp.). On presentation, 1 patient had best-corrected visual acuity (BCVA) of 20/20. The remaining 4 patients had count-fingers to hand motion (HM) vision. All patients underwent immediate surgical intervention for infection control. All patients received oral or intravenous voriconazole and aggressive intravitreal voriconazole every 2-3 days initially. Intravitreal amphotericin was added if there was poor response to voriconazole alone. Three patients achieved a final BCVA of 20/20, 1 patient achieved BCVA of 20/50, and 1 remained HMs only. CONCLUSION: Aggressive treatment of filamentous fungal endophthalmitis with early surgical intervention, systemic antifungal therapy, and frequent intravitreal injections of voriconazole can result in excellent visual outcomes in some patients.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Endophthalmitis/drug therapy , Eye Infections, Fungal/drug therapy , Voriconazole/pharmacology , Adolescent , Adult , Aged , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Endophthalmitis/microbiology , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Female , Fusarium/drug effects , Humans , Intravitreal Injections , Male , Microbial Sensitivity Tests , Middle Aged , Phyllachorales/drug effects , Retrospective Studies , Scedosporium/drug effects , Treatment Outcome , Voriconazole/administration & dosage , Young AdultABSTRACT
BACKGROUND: In order to study the genetics of diseases more accurately and effectively, one often collects large families. Different members of a large family may provide differing information about the structure and make-up of their pedigree. Thus, software is needed to facilitate reconciliation of pedigrees collected independently from multiple informants from a single large family to create a unified pedigree that is based on the best composite information available. FINDINGS: Our implementation demonstrates that Genetic ME performs merging in terms of adding, replacing and combining information from two pedigrees. Through a tracking process, all of the changes made to the data set for the individuals can be traced back to their original source material. A new pedigree structure can be easily visualized while reconciling disparate information from multiple pedigrees. METHODS: We developed the Genetic Merging & Editing (Genetic ME) program, an open source Java application built on top of CraneFoot and Ghostscript, to support comparing, editing and merging of pedigrees collected from multiple sources in a visually-oriented manner. CONCLUSIONS: Genetic ME constitutes an ideal addition to software packages for reconciling pedigree information from multiple sources. Genetic ME provides a friendly graphical user interface, traces the changes made by users, and produces viewable merged pedigree structures able to be further used by other popular analysis programs.
