Endogenous fungal endophthalmitis: international, multicentre, retrospective analysis of clinical outcomes following surgical and medical management, and screening

Wassef, Amr, Breazzano, Mark P., Saeed, Kordo, Kalogeropoulos, Dimitrios, Steel, David H., Chandra, Aman, Hillier, Roxane J., Narayanan, Krishnamoorthy, Mueller, Isabella, Narayanan, Manjusha, Williamson, Tom, Kumaran, Neruban, Gupta, Neha, Hogan, Jacqueline and Gupta, Bhaskar (2025) Endogenous fungal endophthalmitis: international, multicentre, retrospective analysis of clinical outcomes following surgical and medical management, and screening. Eye (Basingstoke), 39, 3249–3256. (doi:10.1038/s41433-025-04061-0).

Abstract

Objectives: To report the clinical outcomes of surgical management versus medical management alone in cases of endogenous fungal endophthalmitis. Additionally, we explore the role of routine ophthalmic screening. Methods: Retrospective observational multicentre study. We examined the databases of five UK centres and a tertiary centre in the United States for patients with Candida septicaemia (candidemia) and/or clinically established endogenous fungal endophthalmitis. Clinical data including visual acuity and other outcomes were reviewed and analysed with statistics. Results: A total of 404 patients were included from all centres. Forty-six eyes were diagnosed clinically as presumed EFE - of which 25 were later confirmed with positive vitreous biopsies. 18/46 received systemic medical treatment with or without intravitreal injection of antifungal agents and without a significant logMAR vision improvement from 1.15 ± 0.29 at baseline to 0.74 ± 0.21 at last follow up. The remaining 28/46 eyes received both systemic medical treatment and vitrectomy, and visual acuity improved from 1.56 ± 0.19 to 1.14 ± 0.21 after surgery (p = 0.04). At the last follow up, 18/28 eyes (64.3%) had an attached retina with no tamponade, three attached under oil and two ending up with detached retina. Silicone oil was retained in three eyes due to either patient comorbidities precluding further surgery or due to surgeon preference to ensure long-term anatomical stability. Two cases resulted in macular and/or fibrovascular scarring and one in enucleation. Out of 359 patients with candidemia, 95 (26.4%) had ophthalmological examination and only 9 (9.47% of those examined and 2.5% of the total) had endogenous fungal endophthalmitis (7 confirmed with vitreous sample cultures and 2 presumed). Conclusion: Although our findings suggest that vitrectomy may improve outcomes in select cases of EFE, the retrospective nature of our study and the potential for bias mandate cautious interpretation. Therefore, further prospective studies are necessary to shed more light with novel insights. A more targeted, case-by-case screening paradigm for patients with candidemia is advocated for optimum outcomes and efficient use of resources.

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Contributors

Author: Kordo Saeed

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