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

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Abstract
Between November 1983 and January 1984, 13 cases of Candida parapsilosis endophthalmitis occurred in Florida, Georgia, and Tennessee [USA] 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 C. 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 C. 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 patients having a cataract extraction or IOLI at the institutions studied are known to have developed C. parapsilosis endophthalmitis.