Implications of early systemic therapy on the incidence of endogenous fungal endophthalmitis

Objective: In the past, evidence of endogenous fungal endophthalmitis has been used as a guide to initiating potentially toxic antifungal therapy in patients with systemic fungal infections. Recently, however, a trend has developed to provide patients with antifungal therapy at the first evidence of fungal infection. The authors' study evaluates the incidence of endogenous fungal endophthalmitis in this setting. Design: The design is a retrospective review of the medical records of patients examined by the inpatient ophthalmology consultation service to rule out endogenous fungal endophthalmitis between January 1994 and April 1996 at the University of Michigan Hospitals, Ann Arbor, Michigan. Participants: Two hundred fourteen eyes of 107 patients with a diagnosis of systemic fungal infection were studied. Intervention: A review of medical records was performed. Main Outcome Measures: The findings of the ocular examination, the presence of risk factors for disseminated fungal infection, the type of antifungal therapy, and the source and identity of the isolated fungus were recorded. Results: The majority of patients examined had either fungal growth from blood cultures or evidence of deep tissue fungal infection. All patients in the study were at risk for fungal disease with each having at least one risk factor for disseminated fungal infection. Of the patients examined, 93.4% already were receiving systemic antifungal therapy at the time of ophthalmologic consultation. Only 3 (2.8%) of the 107 patients examined had chorioretinal findings consistent with early endogenous fungal endophthalmitis. None had intravitreous involvement, and the ocular findings did not change the course of therapy. Conclusions: Early systemic treatment of deep tissue fungal infection appears to dramatically decrease the incidence of endogenous fungal endophthalmitis.