Candida pelliculosa endophthalmitis after cataract surgery: a case report

Area of Science:

• Ophthalmology
• Mycology
• Infectious Diseases

Background:

• Postoperative endophthalmitis is a severe intraocular infection that can occur after cataract surgery.
• Fungal endophthalmitis, though less common than bacterial, poses a significant challenge in diagnosis and management.
• Candida pelliculosa is an opportunistic yeast rarely implicated in ocular infections.

Observation:

• A 57-year-old male developed symptoms of endophthalmitis one month post-cataract surgery, including pain, redness, and decreased vision.
• Ophthalmologic examination revealed anterior chamber inflammation, hypopyon, and microabscesses.
• Standard bacterial endophthalmitis treatment was ineffective, prompting further investigation.

Findings:

• Candida pelliculosa was identified as the causative agent from anterior chamber cultures.
• Systemic antifungal treatment was limited due to patient intolerance (elevated liver enzymes, allergic reaction).
• Successful management included intraocular lens explantation, pars plana vitrectomy, anterior chamber lavage, and multiple intravitreal/intracameral amphotericin B injections.

Implications:

• Candida pelliculosa should be considered in the differential diagnosis of postoperative endophthalmitis, especially with atypical presentations.
• Intraocular amphotericin B administration is a viable and safe treatment option for resistant fungal endophthalmitis, even with systemic sensitivity issues.
• Surgical intervention, including lens explantation and vitrectomy, combined with targeted antifungal therapy, is crucial for managing severe cases of Candida pelliculosa endophthalmitis.