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PEDIATRICS Vol. 110 No. 5 November 2002, pp. e65

ELECTRONIC ARTICLE

Candida (Amphotericin-Sensitive) Lens Abscess Associated With Decreasing Arterial Blood Flow in a Very Low Birth Weight Preterm Infant

Laura Drohan, MD*, Christopher E. Colby, MD*, Mary E. Brindle, MD{ddagger}, Steven Sanislo, MD§ and Ronald L. Ariagno, MD*

* Department of Pediatrics, Division of Neonatal and Developmental Medicine
{ddagger} Department of Surgery, Division of Pediatric Surgery
§ Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California

--> In this report, we review the case of a candidal lens abscess in a premature infant girl who was 28 weeks’ gestational age at birth. The culture obtained from the lens abscess grew Candida albicans sensitive to amphotericin B but resistant to flucytosine. This case is unique in that the infant developed a fungal lens cataract at 34 weeks’ postconceptional age during the last week of a 30-day course of amphotericin B. The embryonic hyaloid artery system, which perfuses the developing lens, regresses between 29 and 32 weeks of gestation; thus, the mechanism for an infection of the lens may be inoculation of the lens by Candida before hyaloid artery system regression, followed by developmental loss of this blood supply, which makes the lens inaccessible to antimicrobial penetration. Candidal endophthalmitis with lens abscess is an uncommon morbidity that requires prompt recognition and surgical intervention for effective management.

Key Words: low birth weight • preterm infant • candida endophthalmitis • lens abscess

Abbreviations: TVL, tunica vasculosa lentis • DOL, day of life • CSF, cerebrospinal fluid • ROP, retinopathy of prematurity • 5-FC, flucytosine

Received for publication Apr 29, 2002; Accepted Jul 25, 2002.