Outbreak of Candida parapsilosis endophthalmitis after cataract extraction and intraocular lens implantation

Abstract

Between November 1983 and January 1984, 13 cases of Candida parapsilosis endophthalmitis occurred in Florida, Georgia, and Tennessee in patients who had had an intraocular lens implantation (IOLI) or cataract extraction with an IOLI. This outbreak followed the introduction in July 1983 of a new brand of balanced salt solution (BSS) used as an intraoperative ophthalmic irrigating solution. This product was subsequently recalled because of intrinsic fungal contamination. A retrospective cohort study including 704 ophthalmology patients at risk for exposure to this brand of BSS revealed that definite exposure to that product was a significant risk factor for Candida parapsilosis endophthalmitis (P<0.001, Fisher exact test). A retrospective case control study including 203 control patients with definite exposure to BSS suggested that exposure to systemic steroids (P=0.007, Fisher exact test) was an additional risk factor for Candida parapsilosis endophthalmitis. Treatment modalities among the 13 patients included topical, intraocular, or systemic antifungal therapy (or a combination of these modalities) in 13 patients and vitrectomy in 10 patients. No patient had systemic symptoms or complete visual loss. Laboratory investigations showed a 6.7% overall contamination of the product with C. parapsilosis. After recall of the product by the manufacturer, no patient having a cataract extraction or IOLI at the institutions studied are known to have developed Candida parapsilosis endophthalmitis.