Endogenous fungal endophthalmitis: results after anti-fungal treatment with or without vitrectomy

Background: Fungal endophthalmitis represents a significant cause of ocular morbidity, affecting in the majority of cases patients in poor general conditions. The eye is typically involved by hematogen dissemination, and the germ induces a chorioretinitis associated with an important panuveitis. Patients and methods: Four patients were examined, They complained of a progressive reduction of vision, associated with photophobia. Ophthalmologic examination disclosed an important panuveitis. Investigations showed a fungal chorio-retinitis in all cases. Risk factors were intra-venous toxicomania, longterm parenteral nutrition and traumatism of the sinuses. Results: Vitreous cultures were positive for Candida albicans (3 patients) and for Aspergillus fumigatus (1 patient), Blood cultures were negative in the four cases. Three patients were treated with anti-fungal medication (fluconazole, itraconazole) associated with a vitrectomy by pars plana. One patient was treated by anti-fungal therapy only. Clinical evolution was satisfactory in all cases. Final vision was 10/10 in three cases and 5/ 10 in one. One patient developed a retinal detachment and an epiretinal membrane. Follow-up was 7 months (2-16 months). Conclusion: The evolution of these four cases suggests that a rapid anti-fungal therapy associated with or without a vitrectomy represent a favourable therapeutic option when a fungal infection is suspected.