- Design
- Retrospective multicentre cohort (8 US academic centres)
- Population
- 118 eyes of 87 patients with endogenous fungal endophthalmitis, 2010–2025
- Primary outcome
- Treatment strategies, surgery and final vision
- Effect
- IV vs oral: surgery 21% vs 50% (adjusted OR 0.33, 0.10–1.06); mould OR 4.26 for worse vision
The authors note that standardised treatment guidelines for endogenous fungal endophthalmitis are lacking. This retrospective cohort from eight US academic centres (2010 to 2025) described 118 eyes of 87 patients.
Most (64%) started on intravenous antifungals, particularly those with systemic symptoms or positive blood cultures; voriconazole (34%) and fluconazole (30%) were the commonest agents. Eyes started on intravenous therapy underwent surgery less often (21% vs 50%), but after adjustment the difference was not significant (OR 0.33, 0.10 to 1.06). Worse presenting vision (OR 1.78) and mould rather than yeast (OR 4.26) were associated with worse final vision.
In India, endogenous fungal endophthalmitis is seen after hospital stays, with intravenous lines, in diabetes and in injecting drug use, and moulds are relatively more common. Early recognition and prompt referral matter more than the route of the first antifungal.
- Dilate and examine the fundus in any septic patient with visual symptoms, floaters or eye pain, and in candidaemic patients even without symptoms, as IDSA advises.
- Refer suspected fungal endophthalmitis the same day to a retina service.
- Obtain intraocular samples where possible; mould carries a much worse prognosis and changes drug choice.
- Choose antifungals with good ocular penetration, such as voriconazole or fluconazole for susceptible yeasts.
Why it matters
Presenting vision and the organism drive outcome, so the gain lies in finding it early.
Don't overread it
The apparent benefit of intravenous therapy disappeared after adjustment; the route of first treatment is not settled.
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