As fungal endophthalmitis
is an emerging challenge, the study was carried out to determine the prevalence and the spectrum of fungal
agents causing endophthalmitis
from a single center, to identify the risk factors, and to correlate clinical course of illness with the agents involved.
The microbiological and clinical records of all fungal endophthalmitis
diagnosed during January 1992 through December 2005 at a tertiary center in India were reviewed retrospectively. During this period, treatment protocol of the patients with fungal endophthalmitis
was pars plana vitrectomy
, instillation of intravitreal amphotericin B (5 μg) and dexamethasone (400 μg). Additionally, oral fluconazole (27 patients) or itraconazole (78 patients) was given in 105 patients.
Results: Fungal endophthalmitis
was diagnosed in 113 patients and they were categorized into: postcataract surgery (53 patients), posttrauma
(48), and endogenous
(12) groups. Aspergillus
species was the most common (54.4%) agent isolated, followed by yeasts (24.6%), and melanized fungi (10.5%). Among Aspergilli, Aspergillus flavus
was the most common (24.6%) species whereas Candida tropicalis
(8.8%) was in the yeast. Other rare agents isolated include Fonsecaea pedrosoi, Fusarium solani, Paecilomyces lilacinus, Pseudallescheria boydii, Colletotrichum dematium, Cryptococcus neoformans,
and Trichosporon cutaneum
. Visual acuity after therapy remained <20/400 in 77.4%, 64.3%, 50.0%, and 16.7% patients infected with Aspergillus
species, yeasts, melanized fungi and other mycelial fungi, respectively. The outcome was unfavorable in 52.8%, 66.7%, and 33.3% patients with postoperative
, and endogenous
This study is the largest series of fungal endophthalmitis
from a single center and highlights the fact that a vast array of fungi can cause endophthalmitis
though Aspergilli are the common agents. The combination of pars plana vitrectomy
and intravitreal amphotericin B with or without fluconazole/itraconazole was the common mode of therapy in such patients. However, the main challenge is suspecting fungal
etiology at the time of presentation and accurately diagnosing those patients.