Endogenous Candida endophthalmitis after two consecutive procedures of suction dilatation and curettage

Endogenous Candida endophthalmitis (ECE) is a rare disease. We present a patient with Candida endophthalmitis after two consecutive procedures of suction dilatation and curettage for elective abortion. A 24-year-old single woman who received a suction dilatation and curettage one week ago developed pain and blurred vision in the right eye. Endogenous Candida endophthalmitis was diagnosed and treated with oral fluconazole and pars plana vitrectomy with adjunction of intravitreal amphotericin B injection. The vitreous culture revealed Candida albicans. The vitreous inflammation subsided greatly after the initial treatment but flared up after the second dilatation and curettage for incomplete abortion 5 days after the vitrectomy. The oral fluconazole was replaced by intravenous amphotericin B, and a second vitrectomy with injection of intravitreal amphotericin B was performed. Postoperatively, the intraocular inflammation resolved gradually. Six months after the second vitrectomy, the best-corrected visual acuity in the right eye was 20/25. The excellent visual acuity of this patient was attributed to the early diagnosis and aggressive treatment. For patients with mild disease, less toxic oral fluconazole as the systemic antifungal agent instead of more toxic intravenous amphotericin B has been recommended. For those with advanced disease, intravitreal amphotericin B in conjunction with vitrectomy has been advocated by many eye surgeons.