Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies

Abstract

Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as awhole organ but also the life of the patient due to its systemic cause. Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. 8patients with 14eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent apars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1patient received parabulbar administration of atriamcinolone depot in both eyes, 7patients received adexamethasone depot in 11eyes and all 8patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2logMar to 1.0logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2patients died from one of the underlying diseases after 3 and 25months, respectively. Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.