Favorable Outcomes of Filamentous Fungal Endophthalmitis Following Aggressive Management.

Purpose: To evaluate the visual outcomes following aggressive management of filamentous fungal endophthalmitis with prompt surgical intervention and oral and intravitreal voriconazole.

Methods: Retrospective chart review study of consecutive patients with culture- or biopsy-proven filamentous fungal endophthalmitis treated at an academic referral center. Clinical characteristics, treatment regimens, and visual outcomes were analyzed.

Results: Included were 5 patients, 1 with endogenous endophthalmitis due to systemic fusariosis and 4 due to exogenous endophthalmitis (1 with Fusarium, 2 with Scedosporium apiospermum, and 1 with Glomerella spp.). On presentation, 1 patient had best-corrected visual acuity (BCVA) of 20/20. The remaining 4 patients had count-fingers to hand motion (HM) vision. All patients underwent immediate surgical intervention for infection control. All patients received oral or intravenous voriconazole and aggressive intravitreal voriconazole every 2-3 days initially. Intravitreal amphotericin was added if there was poor response to voriconazole alone. Three patients achieved a final BCVA of 20/20, 1 patient achieved BCVA of 20/50, and 1 remained HMs only.

Conclusion: Aggressive treatment of filamentous fungal endophthalmitis with early surgical intervention, systemic antifungal therapy, and frequent intravitreal injections of voriconazole can result in excellent visual outcomes in some patients.