TABLE 21.
Ophthalmic mycoses following ocular surgerya
| Ocular surgery | Ophthalmic lesion | Criteria for diagnosis of mycosisb | Fungus isolated | Response to antifungals (antifungals used)c | Surgery needed (type of surgery) | Reference |
|---|---|---|---|---|---|---|
| Radial keratotomy | Keratitis | CF, HPE, CC | Fusarium spp. | Details not provided | Yes (keratoplasty) | Gussler et al., letter |
| Keratitis | CF, HPE, CC | A. fumigatus | No (AB, IC) | Yes (keratoplasty) | 142 | |
| Keratitis | C | C. parapsilosis | Yes (AB, KC) | No | 232 | |
| Keratitis | CF, DM, C | Fusarium spp. | Yes (NT) | No | 285 | |
| Keratitis | CF, DM, C | Aspergillus spp. | Yes (NT) | No | 285 | |
| LASIKd | Keratitis | CF, DM, C | Curvularia spp. | Yes (NT, AB) | No | 63 |
| Keratitis | CF, DM, CC | S. apiospermum | No (NT, KC) | Yes (keratoplasty) | 360 | |
| Keratitis | CF, DM, C | A. flavus | No (NT, KC) | Yes (keratoplasty) | 361 | |
| Keratitis | CF, HPE, CC | Acremonium atrogriseum | No | Yes (keratoplasty) | 317 | |
| Keratitis | HPE, CC | A. fumigatus | Yes | No | 203 | |
| Keratitis | HPE, CC | F. solani | No (econazole, FC, AB, NT, IC, voriconazole) | Yes (keratoplasty 3 times) | 408 | |
| Lamellar keratoplasty | Corneal interface infection | HPE, CC | Rhodotorula spp. | No (NT, AB) | Yes (keratoplasty) | 286 |
| Penetrating keratoplasty | Keratitis, intraocular infection | DM, HPE, CC, pathogenic in animal cornea | Exophiala dermatitidis | No (NT, KC, miconazole) | Yes (keratoplasty twice) | 212 |
| Keratitis, intraocular infection | HPE, CC | Exophiala dermatitidis | No (IC, AB) | Yes (keratoplasty) | 29 | |
| Crystalline keratopathy | HPE, CC | C. guilliermondii | Partial (AB, FC) | Yes (keratoplasty) | 4 | |
| Crystalline keratopathy | DM, C | C. albicans | Partial (AB, KC) | Yes (keratoplasty) | 419 | |
| Keratoplasty dehiscence repair | Keratitis | DM, C | Beauveria bassiana | Partial (NT, FC) | Yes (keratoplasty) | 191 |
| Pterygium excision (no radiation) | Anterior and posterior scleritis | C | S. apiospermum | No (AB, IC, miconazole) | Yes (enucleation) | 379 |
| Pterygium excision (radiation) | Corneoscleritis complicating radionecrosis | HPE, CC HPE, culture of scleral tissue | Scedosporium prolificans Fusarium spp. | Yes (NT, FC, AB) Yes (NT,KC) | Yes (scleral resection) Yes (scleral debridement, plaque removal) | 254 254 |
| HPE, culture of scleral tissue | S. apiospermum | Yes (NT,KC,AB) | Yes (plaque removal) | 254 | ||
| HPE, CC | S. apiospermum | No (NT, AB) | Yes (enucleation) | 254 | ||
| HPE, CC | S. prolificans | Yes | Yes (scleral) | 202 | ||
| debridement) | ||||||
| Scleritis and panophthalmitis | Aspergillus spp. | No (AB, flucytosine, miconazole) | Yes (enucleation) | 230 | ||
| Sclerokeratitis | S. prolificans | No (AB, NT) | Yes (enucleation) | 370 | ||
| Cataract extraction | Scleritis | CF, C | Rhizopus spp.e | No (AB)f | Yes (enucleation) | 221 |
| Scleritis (2 patients) | HPE, culture of scleral tissue | Aspergillus spp. | Yes (IC, econazole, AB) | Yes (scleral excision, patch graft) | 31 | |
| Scleritis | CF, HPE, CC | A. flavus | Yes (AB, KC, IC) | Yes (scleral debridement) | 51 | |
| Trabeculectomy | Scleritis | HPE, culture of scleral tissue | Aspergillus spp. | Yes (AB, IC, econazole) | No | 31 |
| Phacoemulsification and intraocular lens implantation | Keratitis secondary to endophthalmitis | HPE, culture of corneal scrapes and vitreous HPE, culture of vitreous | A. kiliense F. solani | No No | Yes (keratoplasty) Yes (keratoplasty) | 417 417 |
| CF, DM, C (repeated) | C. parapsilosis | Partial (AB, FC) | Yes (debridement) | 88 |
a
Excluding endophthalmitis following cataract surgery.
b
CF, clinical features suggestive of fungal infection; DM, fungal elements in microscopy of scrapes or necrotic material; HPE, fungal elements seen by histopathological examination of biopsy specimens or tissue bits; C, fungi grown in culture from scrapes or necrotic material; CC, fungi grown in culture from corneal button or biopsy specimen.
c
AB, amphotericin B; IC, itraconazole; KC, ketoconazole; NT, natamycin; FC, fluconazole.
d
LASIK, laser-assisted in situ keratomileus.
e
Significance of this isolate is doubtful.
f
Also received hyperbaric oxygen therapy.