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Endogenous fungal endophthalmitis following intensive corticosteroid therapy in severe COVID-19 disease

Daraius Shroff1, Ritesh Narula2, Neelam Atri1

  • 1Shroff Eye Centre, Dr. Shroff's Charity Eye Hospital, New Delhi, India.

Indian Journal of Ophthalmology
|June 19, 2021
PubMed
Abstract

Insights

Severe COVID-19 survivors treated with steroids developed fungal endophthalmitis. Prompt diagnosis and pars plana vitrectomy with antifungal therapy improved vision and controlled infection in these cases.

Area of Science:

  • Ophthalmology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe COVID-19 infection can necessitate prolonged systemic steroid use.
  • Immunocompetent individuals may develop opportunistic infections post-COVID-19.
  • Endogenous fungal endophthalmitis is a rare but serious complication.

Purpose of the Study:

  • To report cases of endogenous fungal endophthalmitis following severe COVID-19.
  • To highlight the role of prolonged systemic steroid therapy in these cases.
  • To describe treatment outcomes and emphasize clinical awareness.

Main Methods:

  • Retrospective chart review of five patients with fungal endophthalmitis post-COVID-19.
  • Analysis of treatment with pars plana vitrectomy (PPV) and intravitreal antifungal therapy.
  • Microbiological analysis of causative fungal species (Candida sp., Aspergillus sp.).

Main Results:

  • Seven eyes of five patients presented with blurred vision and floaters 6 days post-discharge.
  • All patients had received an average of 42 days of systemic steroids for severe COVID-19.
  • Fungal cultures were positive in five eyes; Candida sp. and Aspergillus sp. were identified.
  • All eyes showed infection control and vision improvement after PPV and antifungal treatment.

Conclusions:

  • Endogenous fungal endophthalmitis can occur in immunocompetent individuals after severe COVID-19 and prolonged steroid use.
  • Misdiagnosis as noninfectious uveitis is common.
  • Early diagnosis and prompt surgical and antifungal treatment are crucial for visual recovery.
Keywords:
COVID-19Corticosteroid therapyEndogenous endophthalmitisFloatersFungal endophthalmitisPars plana vitrectomy

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