We thank Chen and associates for their comments and for sharing their experience in the diagnosis and treatment of endogenous fungal endophthalmitis. We will respond to the comments in order. First, as we pointed out in our article, the diagnosis of endogenous fungal endophthalmitis remains challenging; we agree that more sensitive, more rapid, less invasive diagnostic tests for fungal infection would be helpful. As our study suggests, we do not have such tests available for clinical use at our institution. Second, culture-proven sources of infection were not identified in most cases, because nonocular cultures often demonstrate negative results in our experience. The questions posed by Chen and associates regarding the sources of infection are of great interest, but cannot be answered by the limited data available in our retrospective study. Third, Chen and associates point out that “large posterior pole chorioretinal infiltration typically presents a high risk of retinal detachment, even without pars plana vitrectomy, and a poor visual outcome.” Consistent with this comment, we found a high rate of retinal detachment (26%) in our retrospective study. Finally, we applaud the treatment algorithm proposed by Chen and associates. Our study focused exclusively on culture-proven endogenous fungal endophthalmitis. Consequently, most (91%) of the eyes in our study underwent vitrectomy, and our study likely did not capture mild cases, in which a presumptive diagnosis was made and empiric systemic treatment was initiated. We do not use intravitreal steroids when treating cases of fungal endophthalmitis for fear of inhibiting the immune response. Without a well-designed prospective, comparative trial, the additional use of steroids remains controversial.

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Jan 12, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reply

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