Volume.122 Number.12

Original article : Case report

Postoperative Fungal Endophthalmitis Diagnosed Using Culture of a White Mass on the Edge of the Anterior Capsule Following Cataract Surgery in a Stevens-Johnson Syndrome Patient: a Case Report
Hokoru Yoshioka1,2, Hideki Fukuoka2, Kazuhito Yoneda2, Chie Sotozono2
1 Department of Ophthalmology, Fukuchiyama City Hospital
2 Department of Ophthalmology, Kyoto Prefectural University of Medicine

Purpose: To report a case of refractory Stevens-Johnson syndrome (SJS) in which fungal endophthalmitis developed after lens reconstruction.
Case presentation: The patient was a 59-year-old woman with SJS who underwent lens reconstruction because of the progression of an age-related cataract. As preoperative culture of conjunctival sac swab revealed the presence of Candida spp., eye drops containing 0.1% miconazole (hereafter MCZ) were perioperatively administered. As the patient progressed well and the ocular inflammation subsided, the MCZ eye drops were discontinued on postoperative day34. However, intracameral inflammation reappeared and a white mass was identified in the anterior capsule edge according to testing performed with dilated pupils. Anterior capsulectomy was performed on postoperative day91 and a diagnosis of postoperative fungal endophthalmitis was made based on the detection of Candida spp. in the anterior capsule. Treatment was initiated with 0.1% MCZ eye drops and oral voriconazole and improvement was noted. However, as decreased visual acuity that appeared to be a side effect of voriconazole appeared, the drug was discontinued. As the intraocular inflammation subsequently worsened, vitrectomy and intraocular lens extirpation were performed seven months after the cataract surgery. Postoperatively, the fungal endophthalmitis was successively treated by administering 0.1% MCZ eye drops and oral itraconazole.
Conclusion: When performing intraocular surgery on patients with refractory ocular surface disease, care must be taken to prevent opportunistic infections and endophthalmitis due to resistant bacteria.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 928-933, 2018.

Key words
Lens reconstruction, Fungal infection, Endophthalmitis, Candida spp., Stevens-Johnson syndrome
Reprint requests to
Hokoru Yoshioka, M.D. Department of Ophthalmology, Fukuchiyama City Hospital. 231 Atsunaka-cho, Fukuchiyama-shi, Kyoto-fu 620-8505, Japan