GLAUCOMA DRAINAGE DEVICE COMPLICATED BY FUNGAL PARACONIOTHYRIUM ENDOPHTHALMITIS

Abstract

Ten years after BaerveldtTM implantation, a woman underwent immunosuppressive therapy for necrotizing scleritis. She subsequently developed symptoms suggestive of endophthalmitis in the setting of tube exposure. Cultures isolated fungal Paraconiothyrium. She underwent two vitrectomies with anterior chamber washouts, BaerveldtTM device removal, and intraocular and systemic antifungal therapy. The endophthalmitis has since resolved. Purpose: To report the first documented case of Paraconiothyrium fungal endophthalmitis associated with a glaucoma drainage device. Methods: A 74-year-old woman with a history of primary open angle glaucoma had undergone BaerveldtTM glaucoma implantation 10 years earlier. She presented with pain and injection, was diagnosed with necrotizing scleritis, and started on prednisone and methotrexate. She subsequently developed worsening pain, vision loss, and infiltrates suggestive of fungal endophthalmitis, in the setting of an exposed BaerveldtTM tube. Results: Surgical cultures were positive for fungal Paraconiothyrium. The patient underwent two pars plana vitrectomies, anterior chamber washouts, removal of the BaerveldtTM device and intraocular lens, and intraocular and systemic antifungal therapy. The fungal infiltrates and inflammation have since resolved. Conclusions: Fungal endophthalmitis is an exceedingly rare complication of glaucoma drainage device implantation, but must be considered, especially in an immunocompromised patient.

Keywords

• Endophthalmitis [C11.294.265]
• Eye Infections, Fungal [C11.294.450]
• Mycoses [C01.703]
• Glaucoma Drainage Implants [E07.695.250]
• Antifungal Agents [D27.505.954.122.136]