Anterior and Pan-endophthalmitis Caused by Candida albicans and Aspergillus fumigatus: Report of Two Cases

Abstract

We report two posttraumatic fungal endophthalmitis cases with anterior and entire segment involvement caused, respectively, by Candida albicans and Aspergillus fumigatus. The anterior endophthalmitis induced by C. albicans presented multifocal lesions with hyphael structures in anterior chamber, but without involvement of posterior vitreous. The pan-endophthalmitis caused by A. fumigatus displayed significant hypopyon and vitritis. Treatment strategies are anterior chamber cleaning for anterior endophthalmitis and vitrectomy for pan-endophthalmitis, excepting systemic and topical antifungal drug applications including intravitreal injection for both types of endophthalmitis. There is a much better outcome in the case with anterior segment involvement than that with entire segment involvement. This case report provides evidence that the different types of posttraumatic fungal endophthalmitis related to different fungal infections indeed existed and should be managed with different strategies.

Aspergillus fumigatusEndophthalmitis with Necrotizing Scleritis following Pars Plana Vitrectomy

“…Endogenous Aspergillus endophthalmitis may feature prominent yellowish exudative chorioretinal infiltrates with invasion of retinal and choroidal vessel walls [ 2 ]. In contrast, exogenous Aspergillus endophthalmitis may show significant hypopyon and vitritis, with sparing of the retina [ 3 , 4 ]. Culture of vitreous aspirate, in conjunction with examination of Gram- or Giemsa-stained smears, will identify the organism in the majority of cases.…”

The role of surgical debridement in different clinical manifestations of invasive aspergillosis

“… Intraocular Aspergillus infections originate either exogenously (e.g. penetrating trauma and postoperative infections), or endogenously from haematogenous spread, mostly from pulmonary foci or via direct dissemination from paranasal sinuses . Endophthalmitis caused by Aspergillus usually presents with impairment of vision, painful sensation in the eyeball and flocculent material in the anterior chamber.…”

“…penetrating trauma and postoperative infections), or endogenously from haematogenous spread, mostly from pulmonary foci or via direct dissemination from paranasal sinuses. 29,30 Endophthalmitis caused by Aspergillus usually presents with impairment of vision, painful sensation in the eyeball and flocculent material in the anterior chamber. Diagnostic approaches in suspected Aspergillus infection of the eye consist of fundoscopic examination, ultrasonography of the eyeball and examination of visual acuity, to analyse the extension of the infected tissue.…”