First Report of Intraocular Madurella Infection Following Phacoemulsification

Atikah A¹ and Bastion MLC^1,

¹Department of Ophthalmology, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff 56000 Cheras, Kuala Lumpur

Cite this paper:
Atikah A and Bastion MLC. First Report of Intraocular Madurella Infection Following Phacoemulsification. Neuro-Ophthalmology & Visual Neuroscience. 2020; 5(1):4-7. doi: 10.12691/novn-5-1-3

Abstract

Purpose: To report the first case of post phacoemulsification endophthalmitis secondary to Madurella fungal infection. Method: A case report. Case Presentation: A 51-year-old female referred for post-operative chronic endophthalmitis. She complained of right painless reduced visual acuity (VA). She had undergone uneventful bilateral phacoemulsification with lens implantation four weeks earlier. Her clinical conditions were normal until after about four weeks postoperatively when she presented with signs of right eye endophthalmitis. She then underwent right eye vitreous aspiration needle tap and intravitreal antibiotics. Removal of the intraocular lens was done subsequently. Examination revealed a vision of counting fingers due to hypopyon and 4+ anterior chamber cells associated with fibrinous white exudate in capsular remnant, grade 4 vitreous inflammation with flat retina on ultrasonography. Urgent vitreous biopsy, vitrectomy, removal of the capsular bag, and intravitreal vancomycin and ceftazidime had been performed. White exudates were adherent to the capsular bag, the posterior surface of the iris, and the ciliary processes with sparing of the retina and optic nerve. Gram-positive cocci and fungus of Madurella sp were isolated via the vitreous biopsy. Initially the patient responded well to antibiotics but one month later had a recurrence. Revision vitrectomy and intravitreal voriconazole injection was performed. Oral and topical antifungals were tapered over three months with judicious steroid use. At six weeks post-operatively, her best corrected VA was 6/18, N18. Conclusions: Chronic and recurrent endophthalmitis following phacoemulsification may be due to Madurella fungus. Complete removal of the capsular bag and discrete areas behind the iris and the ciliary processes where fungal hyphae may hide is mandatory. Madurella tends to be locally invasive and spares the retina and optic nerve. It responds well to systemic itraconazole and intravitreal voriconazole.

Keywords:
Madurella phacoemulsification endophthalmitis infection

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