Abstract
Background
Infectious diseases and ophthalmology professional societies have disagreed regarding ocular screening in patients with candidemia. This study aimed to summarize the current evidence on the prevalence of ocular candidiasis (OC) and
Candida endophthalmitis (CE) according to the standardized definitions.
Methods
A literature search was conducted from the 1990s through October 16th, 2022, using PubMed, Emb ase, and SCOPUS. Pooled prevalence of ocular complications was derived from generalized linear mixed models. (PROSPERO CRD42022326610)
Results
A total of 70 and 35 studies were included in the meta-analysis for OC and concordant CE (chorioretinitis with vitreous involvement), respectively. This study represented 8,599 patients with candidemia who underwent ophthalmologic examination. The pooled prevalence [95% confidence interval] of OC, overall CE, concordant CE, and discordant CE were 10.7% [8.4%-13.5%], 3.1% [2.1%-4.5%], 1.8% [1.3%-2.6%], and 7.4% [4.5%-12%] of patients screened, respectively. Studies from Asian countries had significantly higher concordant CE prevalence of patients screened [95% CI] of 3.6% [2.9% - 4.6%] compared to studies from European countries of 1.4% [0.4% - 5%] and American countries of 1.4% [0.9% - 2.2%], p-value <0.01. Presence of total parenteral nutrition and
C. albicans were associated with CE with p ooled odds ratios [95% CI] of 6.92 [3.58–13.36] and 3.02 [1.67–5.46], respectively.
Conclusion
Prevalence of concordant CE overall and among Asian countries was two-times and four-times higher than the prevalence previously reported by American Academy of Ophthalmology of < 0.9%, respectively. There is an urgent need to study optimal screening protocols and to establish joint recommendations by the Infectious Diseases and Ophthalmology Societies.
