Endogenous Fungal Endophthalmitis Following Covid-19 Hospitalization: Evidence From a Year-Long Observational Study; [Endophtalmie Fongique Endogene Suite a Une Hospitalisation Pour Covid-19 : Preuves D'une Etude Observationnelle D'un An] Publisher Pubmed



Fekri S^{1, 2} ; Khorshidifar M^{1, 2} ; Esfahanian F³ ; Veisi A¹ ; Nouri H^{1, 3, 4} ; Abtahi SH^{1, 5, 6}
Source: Journal Francais d'Ophtalmologie Published:2023

Abstract

Purpose: To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). Methods: This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization ± intensive care unit admission were identified, documented, managed, followed up, and described. Results: Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28 days (14–45); the mean time from discharge to onset of visual symptoms was 22 days (0–35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had “creamy-white fluffy lesions” at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7–10 months – the final visual outcome improved from CF to 20/200–20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. Conclusion: Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use – even without other well-known risk factors. © 2023 Elsevier Masson SAS