Favorable Outcomes of Filamentous Fungal Endophthalmitis Following Aggressive Management.

PURPOSE

To evaluate the visual outcomes following aggressive management of filamentous fungal endophthalmitis with prompt surgical intervention and oral and intravitreal voriconazole.

METHODS

Retrospective chart review study of consecutive patients with culture- or biopsy-proven filamentous fungal endophthalmitis treated at an academic referral center. Clinical characteristics, treatment regimens, and visual outcomes were analyzed.

RESULTS

Included were 5 patients, 1 with endogenous endophthalmitis due to systemic fusariosis and 4 due to exogenous endophthalmitis (1 with Fusarium, 2 with Scedosporium apiospermum, and 1 with Glomerella spp.). On presentation, 1 patient had best-corrected visual acuity (BCVA) of 20/20. The remaining 4 patients had count-fingers to hand motion (HM) vision. All patients underwent immediate surgical intervention for infection control. All patients received oral or intravenous voriconazole and aggressive intravitreal voriconazole every 2-3 days initially. Intravitreal amphotericin was added if there was poor response to voriconazole alone. Three patients achieved a final BCVA of 20/20, 1 patient achieved BCVA of 20/50, and 1 remained HMs only.

CONCLUSION

Aggressive treatment of filamentous fungal endophthalmitis with early surgical intervention, systemic antifungal therapy, and frequent intravitreal injections of voriconazole can result in excellent visual outcomes in some patients.