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Original Investigation |

Prolonged Curvularia Endophthalmitis Due to Organism Sequestration

Aleksandra V. Rachitskaya, MD1; Ashvini K. Reddy, MD1,2; Darlene Miller, DHSc, MPH1; Janet Davis, MD1; Harry W. Flynn Jr, MD1; William Smiddy, MD1; Wilfredo Lara, MD3; Selina Lin, MD4; Sander Dubovy, MD1; Thomas A. Albini, MD1
[+] Author Affiliations
1Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, Florida
2Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville
3Retina Macula Specialists of Miami, Miami, Florida
4Kaufman Eye Institute, Zephyrhills, Florida
JAMA Ophthalmol. 2014;132(9):1123-1126. doi:10.1001/jamaophthalmol.2014.1069.
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Importance  Endophthalmitis caused by Curvularia is a rare condition seen after cataract surgery and trauma. The clinical course has not been described previously.

Objective  To examine the clinical course of 6 postoperative and trauma-related cases of Curvularia endophthalmitis.

Design, Setting, and Participants  Retrospective case series. We reviewed the archives of the microbiology laboratory of Bascom Palmer Eye Institute, a tertiary referral hospital, from January 1, 1980, through September 30, 2013, to identify cases of Curvularia endophthalmitis. Data collected included demographic information, the cause of endophthalmitis, presenting features, treatment course, the number of recurrences, the area of organism sequestration, and final visual outcome.

Exposures  Trauma and cataract surgery.

Main Outcomes and Measures  Times from the inciting event to presentation of symptoms, diagnosis, and eradication; visual acuity; and identification of the area of sequestration.

Results  We identified 6 patients with Curvularia endophthalmitis, including 5 who underwent cataract surgery and 1 after trauma. The diagnosis was established rapidly in the trauma case. In the postoperative cases, the time from the surgery to first symptoms ranged from 2 to 5 months; from the surgery to correct diagnosis, 7 to 24 months; and from the surgery to eradication, 8 to 27 months. Despite aggressive antifungal therapy, eradication of the infection could be achieved only by identification and removal of the nidus of sequestration. The median follow-up was 29.5 months.

Conclusions and Relevance  In cases of endophthalmitis caused by Curvularia, the diagnosis and treatment are often delayed, especially in postoperative cases. The eradication of the organism requires identification and removal of the nidi of sequestration.

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Figure.
Nidi of Sequestration in Curvularia Endophthalmitis

A, A hypopyon and an iris lesion, representing a nidus of Curvularia sequestration, in a patient with pseudophakia (case 1). B, Corneal laceration repair with corneal infiltrate harboring Curvularia organisms in a trauma patient (case 2). C, Histopathologic photomicrograph of Curvularia organisms in the corneal stroma of the trauma patient (Gomori methenamine silver, original magnification ×100) (case 2). D, Posterior capsular opacity and Curvularia endophthalmitis in a patient with pseudophakia (case 3).

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