The Incidence of Ocular Complications in Candidemic Patients and Implications for the Practice of Routine 
Eye Exams

Abstract

Background Ocular candidiasis is a known complication of candidemia. Given the poor ocular penetration of echinocandins, there is some concern that the increasing use of echinocandins may portend an increased incidence of ophthalmic complications. We examined the changing trends in antifungal prescribing patterns and the incidence of ophthalmic complications following candidemia. Methods Patients with blood cultures positive for Candida species between January, 2014 and June, 2020 who underwent screening fundoscopic examination by an ophthalmologist were analysed. Chi squared analysis was used to compare antifungal prescriptions and ocular exam findings before and after 2016. Trend analysis was also performed to assess temporal changes in prescribing practices and eye exam findings. Results There were 226 candidemia cases during the study period of which 129 (57.1%) underwent screening eye exams. From 2014-2015, 24/37 (64.5%) patients received eye-penetrating antifungals compared to 36/92 (39.1%) from 2016-2020 (p=0.008). Overall 30/129 (23.3%) patients had abnormal eye exams with the prevalence of abnormal findings being 7/37 (18.9%) before 2016 compared to 23/92 (25%, p= 0.46) thereafter. A trend analysis revealed an increase in abnormal eye findings over the study period (p=0.008). Of the 30 patients who had abnormal eye exams, nine (30%) had a change in systemic antifungal therapy from echinocandins to eye-penetrating antifungals. Echinocandin use was associated with abnormal eye findings Conclusion Prescription of eye-penetrating antifungals for candidemia has trended down since 2016. This was associated with a concomitant increase in abnormal findings on screening fundoscopy. Abnormal eye exams were not uncommon throughout our study period