双眼内源性真菌性眼内炎1例.

The patient was a 32-year-old woman who presented with “right eye vision loss with floating dark shadow for 10 days”. The patient had a history of anemia, a hemoglobin of 71.0g/L, and no history of other systemic diseases. The best corrected visual acuity was 0.05 and 1.0 in the right (OD) and left eye (OS), respectively. In the right eye, the conjunctival was mildly congested with significant anterior chamber reaction (Tyndall (+++)) and 1mm hypopyon. The vitreous was moderately cloudy and the fundus examination revealed a blurred view of flat retina. Optical coherence tomography (OCT) in the right eye showed a localized proliferative epiretinal membrane in the temporal macula, and the signal below is obscured. Fluorescein fundus angiography showed slight leakage of fluorescence in the late phase from retinal vessels in the right eye. The patient was initially diagnosed with right uveitis, which improved after local glucocorticoid therapy. More than 1 month later, the patient returned to the doctor due to continued and worsening vision loss in both eyes. The visual acuity decreased to FC/BE (OD) and FC/50cm (OS). The fundus was indistinct due to vitreous opacity in the right eye. Tyndall was positive with a 0.5 mm hypopyon and moderately cloudy vitreous body in the left eye. The fundus was blurred and a suspected yellowish-white lesion was observed between the optic disc and macula in this eye. To determine the cause, the patient was treated with vitrectomy combined with epiretinal membrane stripping on right eye. The vitreous obtained during the operation was smeared and cultured for bacteria and fungi. At the same time, the vitreous was sent for metagenomic next-generation sequencing, which showed Candida albicans (+). It was confirmed by further G-test, even though the smear and culture results were negative. The revised diagnosis was bilateral endogenous fungal endophthalmitis (EFE), and examination revealed that the patient had fungal vaginitis. The patient was immediately treated with bilateral intravitreal injection of voriconazole combined with systemic voriconazole. After that, vitrectomy combined with epiretinal membrane peeling was performed in the left eye due to no significant improvement. Thereafter, the patient’s binocular symptoms improved, visual acuity increased, and there has being no recurrence so far. Discussion and experience: Endogenous fungal endophthalmitis is easily misdiagnosed as uveitis in the early stage, especially in patients with no underlying disease. It is necessary to improve the awareness of this disease, carefully inquire about patients’ history, initiate antifungal treatment as soon as possible, and consider vitrectomy if necessary. [ABSTRACT FROM AUTHOR]