Management of an endogenous bilateral endophthalmitis by Cándida

Author: Sandra Gómez Perera (Spain)

Co-authors: Luis Mateo Cordovés Dorta, Hugo E. Tapia Quijada, Rocío Falcón Roca, Carla Arteaga Henríquez

Purpose

Candida is the most common cause of endogenous fungal endophthalmitis. The treatment of candidemia as well as that of endophthalmitis has been discussed.

Setting/Venue

Retina section of the University Hospital of the Canary Islands-Spain

Methods

We present the case of a patient with candidemia with no apparent focus. He presented secundary chorioretinitis and vitritis and whose approach involved systemic treatment with voriconazole. On the same day of diagnosis, he received an intravitreal injection of voriconazole 100 mcg / 0.1 ml in both eyes. Given the limited response, a vitrectomy was proposed, initially bilateral but due to the general condition of the patient, it was performed only in the LE, which is the eye with the most intense vitritis. Intravitreal treatment with voriconazole was repeated at the time of surgery and at 48h. The microbiological result of the vitreous sample confirmed the diagnosis of intraocular infection by Candida.

Results

Depending on the degree of intraocular involvement, they can be treated with systemic, intraocular or combined antifungal agents. In this case after initial treatment the patient's vision is 0.8 in both eyes and he present isolated foci of chorioretinitis in the periphery, he is only receiving systemic treatment with intravenous fluconazole and anidulafungin.

Conlusions

Early vitrectomy decreases the incidence of late retinal detachment and is recommended in patients with severe vitreous involvement.

Financial Disclosure

No financial disclosure statment