Fungal endophthalmitis

Fungal endophthalmitis occurs secondary to trauma, as a complication of intraocular surgery, or as an extension of an adjacent or distant focus of fungal infection. In the United States, Candida species are the most common pathogens isolated, followed by Aspergillus species. Candida infections show a predilection towards vitreous involvement, whereas Aspergillus infections usually manifest as hemorrhagic infarcts of the retinal or choroidal vessels or as infiltration of the subretinal and subretinal pigment epithelial spaces. Endogenous Aspergillus endophthalmitis is associated with a high mortality rate, underscoring the severity of systemic infection. The prognosis of fungal endophthalmitis depends on the virulence of the organism, extent of intraocular involvement, and the timing and mode of interventions. Prompt therapy following early diagnosis helps to reduce significant visual loss. Despite the introduction of new-generation triazoles and echinocandins into clinical practice, successful therapy is limited by the delay in diagnosis and a lack of broad-spectrum antifungals with good intravitreal penetration that lack systemic toxicity.