1The Medical College of Qingdao University, Qingdao 266071, China2Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical Unversity(Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology Shandong First Medical University, Jinan 250021, China
Abstract：Objective: To analyze the clinical and etiological characteristics of patients with fungal keratitis secondary to infectious endophthalmitis who required evisceration. Methods: In this retrospective case series study, a total of 44 patients (44 eyes) who were diagnosed with fungal keratitis secondary to infectious endophthalmitis and underwent evisceration from January 2012 to December 2021 were collected in Shandong Eye Hospital. The course of the disease and its predisposing factors, ocular and systemic history, clinical manifestations, microbial culture and drug sensitivity test results were analyzed. Results: The 44 patients included accounted for 2.15% of the total cases of fungal keratitis diagnosed by Shandong Eye Hospital in the same period. The median course of the disease was 18.5 days. At admission, 44 eyes had no light perception, and 20 eyes (45%) were complicated with secondary glaucoma. All 44 eyes showed corneal ulcer, involving the whole corneal layer and limbus, and 27 eyes (61%) complicated with anterior chamber empyema. A total of 39 eyes (89%) of microbial culture had fungal growth, including 20 eyes (51%) of Fusarium, 8 eyes (21%) of Aspergillus, 2 eyes (5%) of Alternaria, others including 4 eyes (10%) of Nonsporulating molds, 2 eyes (5%) of Pythium insidiosum, 1 eye (3%) of Scedosporium apiospemum, 1 eye (3%) of Sarocladium, 1 eye (3%) of Phialemoniopsis pluriloculosa. The geometric mean of the minimum inhibitory concentration values of amphotericin B, posaconazole, voriconazole, itraconazole, 5-fuorocytosine, fuconazole, anifensin, micafungin and caspofungin cultivated in this study were 1.597, 1.338, 1.926, 3.291, 64, 189.699, 1.36, 1.16, 1.23 μg/ml. Conclusions: The patients with infectious endophthalmitis secondary to fungal keratitis often present with total corneal ulceration. In addition to the common pathogenic bacteria of Fusarium, Aspergillus and Alternaria, other bacteria with strong pathogenicity and invasiveness such as Nonsporulating molds, Pythium insidiosum and Scedosporium apiospemum are also common.
浙公网安备 33030202001892号