ASPERGILLUS ENDOPHTHALMITIS - STARTING FROM A TUNNEL INCISION
R. Augsten, E. Königsdörffer, M. Blum, J. Strobel
Postoperative Aspergillus endophthalmitis is very rare. Aspergillus infections after cataract operations - starting from a tunnel incision - have been reported scarcely. Therefore, the progress of such a case shall be described.
Patient: A 75-year-old woman underwent a cataract operation in the right eye in February 1997 in a foreign clinic (phacoemulsification and posterior chamber lens implantation). Postoperatively, a chronic iritis with fibrin reactions in the anterior chamber has been observed. In December 1997 the patient was admitted to our hospital because of the begins of endophthalmitis in the front region of the right eye (infiltration and ulceration of the cornea in the area of the tunnel incision with hypopyon). The visual acuity was light perception. Owing to fibrin membranes, there was no view into the fundus. Ultrasonographically the vitreous body was clear. At first, when the germs were unknown, the patient received medical attendance with antibiotics. In view of impaired signs, a pars plana vitrectomy with lens explantation and total removal of the capsular sac must be performed. In the material of the anterior chamber Aspergillus was detected. Therefore, a medical treatment was initiated including an intravitreal, intravenous, subconjunctival and local antimycotic therapy. Because of comeal impairements a keratoplasty with removal of the comeoscleral region of the tunnel incision as well as a re-ppv were necessary. In the corneoscleral cultures numerous fungal hyphae were detectable. Owing to pvr ablation, a further ppv including silicone oil application was accomplished.
Result: In the material of the anterior chamber Aspergillus was detected. Moreover, also in the corneal abrasion material as well as in the comeoscleral cultures fungal hyphae were identified. After the first ppv and the intensive antimycotic therapy, the visus in the right eye was found to be unchanged (light perception). By the end of the clinical attendance, in the end of January 1998, following statements were established: visus 1/25, the corneal transplantat was clear and the retina attached.
Conclusion: After cataract operations fungal contaminations with Aspergillus cannot be excluded in every case. Such infections require an intensive operative and conservative therapy. The strategy of medical treatment, however, depends on the peculiarity of the particular case.
University Eye Hospital, Bachstraße 18, D-07740 Jena