Endogenous fungal endophthalmitis post COVID-19.

Author: Daraius Shroff (India)

Co-authors: Ritesh Narula, Neelam Atri, Gagan Bhatia, Arindam Chakravarti, Arpan Gandhi, Shishir Narain

Purpose

To report endogenous fungal endophthalmitis, post recovery from severe COVID-19 infection in otherwise immunocompetent individuals, treated with prolonged systemic steroids.

Setting/Venue

Two tertiary care referral ophthalmic institutions in North India.

Methods

Retrospective chart review of cases with endogenous fungal endophthalmitis post severe COVID-19 infection treated at two tertiary care referral eye institutes in North India.

Results

Seven eyes of five cases of endogenous fungal endophthalmitis were studied. All cases had been hospitalized for severe COVID-19 pneumonia and had received systemic steroid therapy for an average duration of 42 +/- 25.1 days (Range 18 - 80 days). All the cases initially complained of floaters with blurred vision after an average of 6 days (range 1 to 14 days) following discharge from hospital. They had all been misdiagnosed as noninfectious uveitis by their primary ophthalmologists. All eyes underwent pars plana vitrectomy with intravitreal antifungal therapy. Five of the seven eyes grew fungus as the causative organism (Candida sp. in four eyes, Aspergillus sp. in one eye). Post-operatively, all eyes showed control of the infection with marked reduction in vitreous exudates and improvement in vision.

Conlusions

Floaters and blurred vision developed in patients after they recovered from severe COVID-19 infection. They had received prolonged corticosteroid treatment for COVID as well as for suspected noninfectious uveitis. We diagnosed and treated them for endogenous fungal endophthalmitis. All eyes showed anatomical and functional improvement after pars plana vitrectomy with antifungal therapy. It is important for ophthalmologists and physicians to be aware of this as prompt treatment could control the infection and salvage vision.

Financial Disclosure

NIL