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ABSTRACT
Introduction
Fungal Endophthalmitis is a potentially blinding condition, and difficult to treat. It is more often reported from Asia, including India. The mainstays of treatment are vitrectomy and intravitreal injection of antifungal agents.
Areas Covered
The current clinical and microbiological diagnoses of fungal endophthalmitis, both exogenous and endogenous, are discussed. The mechanisms of action and delivery routes of antifungal agents are discussed. The characteristics of endophthalmitis caused by three common species, Aspergillus, Candida, and Fusarium are described. Published data from 2009 to 2019 from India and additional data collected from 7 large referral centers spread across India are presented.
Expert Opinion
Published data suggest a clear benefit from vitrectomy and intravitreal antifungals agents in fungal endophthalmitis though it is likely that many eyes are initially treated with intravitreal bacterial antibiotic only. This is probably related to lack of unequivocal clinical differentiation. Possibly not much harm is inflicted if the specific treatment is instituted as soon as laboratory evidence is available. The future research should focus on early clinical and laboratory diagnosis. Big data analysis to identify the clinical biomarkers and newer laboratory technology to early detection of fungal infection should improve management of this condition that has a poor prognosis.
Article highlights
Vitrectomy with intravitreal antifungal agent is the mainstay of treatment for fungal endophthalmitis
Most patients require repeat therapy and prognosis is comparatively worse than bacterial endophthalmitis.
The clinical symptoms and signs are only indicative, not confirmatory of fungal infection
Microscopy and culture confirm infection though most times the primary empirical treatment continues to be intravitreal bacterial antibiotics similar to bacterial endophthalmitis.
There is a limited choice of antifungal medications and many patients would require systemic therapy for four to 6 weeks
A prospective clinical trial is not possible, but the big data and artificial intelligence could help in clinical classification, designing individualized treatment strategy and prognostication.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose