Abstract
Between November 1983 and January 1984, 13 cases of Candida parapsilosis endophthalmitis occurred in Florida, Georgia, and Tennessee in patients who had had an intraocular lens implantation (IOLI) or cataract extraction with an IOLI. This outbreak followed the introduction in July 1983 of a new brand of balanced salt solution (BSS) used as an intraoperative ophthalmic irrigation solution. This product was subsequently recalled because of intrinsic fungal contamination. A retrospective cohort study including 704 ophthalmology patients at risk for exposure to this brand of BSS revealed that definite exposure to that product was a significant risk factor for C. parapsilosis endophthalmitis (P less than 0.001, Fisher exact test). A retrospective case control study including 203 control patients with definite exposure to BSS suggested that exposure to systemic steroids (P = 0.007, Fisher exact test) was an additional risk factor for C. parapsilosis endophthalmitis. Treatment modalities among the 13 patients included topical, intraocular, or systemic antifungal therapy (or a combination of these modalities) in 13 patients and vitrectomy in 10 patients. No patients had systemic symptoms or complete visual loss. Laboratory investigations showed a 6.7% overall contamination of the product with C. parapsilosis. After recall of the product by the manufacturer, no patients having a cataract extraction or IOLI at the institutions studied are known to have developed C. parapsilosis endophthalmitis.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- FRANCOIS J., DE VOS E., HANSSENS M., ELEWAUT-RIJSSELAERE M. [Intra-ocular mycoses]. Ann Ocul (Paris) 1962 Feb;195:97–119. [PubMed] [Google Scholar]
- Gilbert C. M., Novak M. A. Successful treatment of postoperative Candida endophthalmitis in an eye with an intraocular lens implant. Am J Ophthalmol. 1984 May;97(5):593–595. doi: 10.1016/0002-9394(84)90378-7. [DOI] [PubMed] [Google Scholar]
- Mosier M. A., Lusk B., Pettit T. H., Howard D. H., Rhodes J. Fungal endophthalmitis following intraocular lens implantation. Am J Ophthalmol. 1977 Jan;83(1):1–8. doi: 10.1016/0002-9394(77)90181-7. [DOI] [PubMed] [Google Scholar]
- O'Day D. M. Value of a centralized surveillance system during a national epidemic of endophthalmitis. Ophthalmology. 1985 Mar;92(3):309–315. doi: 10.1016/s0161-6420(85)34035-6. [DOI] [PubMed] [Google Scholar]
- Painter B. G., Isenberg H. D. Isolation of Candida parapsilosis: report of two cases. Am J Clin Pathol. 1973 Jan;59(1):62–65. doi: 10.1093/ajcp/59.1.62. [DOI] [PubMed] [Google Scholar]
- Pettit T. H., Olson R. J., Foos R. Y., Martin W. J. Fungal endophthalmitis following intraocular lens implantation. A surgical epidemic. Arch Ophthalmol. 1980 Jun;98(6):1025–1039. doi: 10.1001/archopht.1980.01020031015002. [DOI] [PubMed] [Google Scholar]
- Ray T. L. Fungal infections in the immunocompromised host. Med Clin North Am. 1980 Sep;64(5):955–968. doi: 10.1016/s0025-7125(16)31576-0. [DOI] [PubMed] [Google Scholar]
- Stern W. H., Tamura E., Jacobs R. A., Pons V. G., Stone R. D., O'Day D. M., Irvine A. R. Epidemic postsurgical Candida parapsilosis endophthalmitis. Clinical findings and management of 15 consecutive cases. Ophthalmology. 1985 Dec;92(12):1701–1709. doi: 10.1016/s0161-6420(85)34095-2. [DOI] [PubMed] [Google Scholar]
- Stransky T. J. Postoperative endophthalmitis secondary to Candida parapsilosis. A case treated by vitrectomy and intravitreous therapy. Retina. 1981;1(3):179–185. [PubMed] [Google Scholar]
- de Jong P. T., Strous C., Filedt Kok J. P. Glutathione bicarbonate Ringer's intraocular irrigation fluid. Prospective double-blind study. Ophthalmologica. 1983;186(1):35–40. doi: 10.1159/000309258. [DOI] [PubMed] [Google Scholar]