An Outbreak of Early-Onset Endophthalmitis Caused by<i>Fusarium</i>Species following Cataract Surgery

Abstract

PURPOSE: This study aimed to report an outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery. METHODS: The study was designed retrospectively to review microbiologic and medical records of eight cases of endophthalmitis caused by Fusarium species after cataract surgery performed in the same operating room and on the same date by different surgeons at Beyoğlu Eye Training and Research Hospital in Istanbul, Turkey. Seven patients had phacoemulsification and intraocular lens implantation surgery. Intracapsular cataract extraction was performed in one patient. The common feature of these surgeries was the use of intracameral injections of cefuroxime (1 mg in 0.1-ml balanced salt solution-BSS) solutions, which were preoperatively prepared from the same BSS bottle. RESULTS: The duration between cataract surgery and the diagnosis of endophthalmitis was four days. Aqueous and vitreous specimens obtained from the patients grew fungus colonies that were identified according to their morphologic features and considered to be Fusarium solani. All patients underwent multiple vitrectomies with silicone oil injections. Patients were given local and systemic antifungal agents (amphotericin B and voriconazole). One patient with corneal involvement underwent evisceration despite a variety of treatments. One patient with unregulated diabetes was prephthisic without recurrence of infection. The final visual acuity of patients was between light perception and 20/100. CONCLUSION: Fusarium should be considered in the differential diagnosis of early-onset endophthalmitis after cataract surgery. An aggressive treatment with local and systemic antifungal agents and multiple vitrectomies with silicone oil injection is helpful in the management of postoperative early-onset Fusarium endophthalmitis. In the prevention of such outbreaks, it is important to use solutions prepared differently for each patient.