An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea
-
Published:2023-03-01
Issue:3
Volume:141
Page:226
-
ISSN:2168-6165
-
Container-title:JAMA Ophthalmology
-
language:en
-
Short-container-title:JAMA Ophthalmol
Author:
Kim Seong Woo1, Kim Jae Hui2, Choi Mihyun1, Lee Sang Joon3, Shin Jae Pil4, Kim June Gone5, Kang Se Woong6, Park Kyu Hyung7, Nam Dong Heun8, Lee Dae Yeong8, Park Young-Hoon8, Park Young-Gun8, Kim Mirinae8, Choi Soon-Il8, Kim Min8, Lee Junwon8, Moon Sang Woong8, Chung Hyewon8, Lee Young Hoon8, Lee Min Woo8, Shin Jae Pil8, Park Dong Ho8, Park Han Sang8, Kang Yong Koo8, Chung In Young8, Yoo Woong-Sun8, Cho Yong-Wun8, Kim Yu Cheol8, Kang Kyung Tae8, Jang Ji Hye8, Kim Seong-Woo8, Choi Kwang-Eon8, Choi Mihyun8, Nam Ki Tae8, Kim Young Ho8, Ahn So Min8, Lee Sang Joon8, Lim Jae Wan8, Ku Hee Chan8, Yoo Su Jin8, Choi Moon Jung8, Lew Young Ju8, Kim Jae Hui8, Kim Joo Yeon8, Hwang Jae Hyung8, Lee Seung Woo8, Bae Kunho8, Jeong Woo Jin8, Kwon Yoon Hyung8, An Seoung Hyun8, Ahn Jeeyun8, Shin Joo Young8, Byon Ik Soo8, Park Sung Who8, Park Kyu Hyung8, Kang Se Woong8, Ham Don-Il8, Kim Sang Jin8, Park Un Chul8, Oh Baek Lok8, Kim June-Gone8, Lee Joo Yong8, Lee Jun Yeop8, Kim Yoon Jeon8, Chae Ju Byung8, Kim Dong Yoon8, Lee Christopher Seungkyu8, Cho Kwan Hyuk8, Kim Min Seok8, Kim Seong Wook8, Lee Jung Pil8, Kim Hoon Dong8, Cho In Hwan8, Song Ji Hun8, Lee Ki Hwang8, Kwon Han Jo8, Lee Seung Min8, Sagong Min8, Lee Tae Gon8, Han Jung Il8, Chang Young Suk8, Min Jung Kee8, Yang Yun Sik8, Kim Soo Han8, Chin Hee Seung8, Ji Yong Sok8, Lee Jong Young8, Kim Seong Taeck8, Shin Min Ho8, Kim Jee Taek8, Han Yong Seop8, Lee Woo Hyuk8, Jo Young Joon8, Kim Jung Yeul8, Kim Kyung Tae8, Seo Eoi Jong8, Lim Sun Taek8, Lee Jun Sung8, Kim Chang Ryong8, Hwang Daniel Duck-Jin8, Kim Ha Kyoung8, Ma Dae Joong8, Hong In Hwan8, Cho Bum Joo8, Shin Yong Un8, Cho Heeyoon8, Ahn Seong Joon8,
Affiliation:
1. Department of Ophthalmology, Korea University Guro Hospital, Seoul, Korea 2. Kim’s Eye Hospital, Seoul, Korea 3. Department of Ophthalmology, Kosin University College of Medicine, Busan, Korea 4. Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea 5. Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea 6. Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 7. Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea 8. for the Korean Retina Society members
Abstract
ImportanceFungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis.ObjectiveTo report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea.Design, Setting, and ParticipantsThis was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022.Main Outcomes and MeasuresThe clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up.ResultsThe fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%).Conclusions and RelevanceThis was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.
Publisher
American Medical Association (AMA)
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|