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The Diagnosis and Treatment of Fungal Endophthalmitis: An Update

Ciprian Danielescu1, Horia Tudor Stanca2, Raluca-Eugenia Iorga1

  • 1Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Strada Universitatii No. 16, 700115 Iasi, Romania.

Diagnostics (Basel, Switzerland)
|March 25, 2022
PubMed

Insights

Fungal endophthalmitis (FE) is often caused by molds like Aspergillus and Fusarium, with Candida prevalent in endogenous cases. Newer diagnostic methods like PCR and next-generation sequencing offer improved sensitivity for identifying fungal pathogens.

Area of Science:

  • Ophthalmology
  • Medical Mycology
  • Infectious Diseases

Background:

  • Fungal endophthalmitis (FE) presents diverse etiologies, with molds (Aspergillus, Fusarium) frequently implicated in exogenous forms and Candida in endogenous FE.
  • Geographical variations significantly influence the prevalence of specific fungal species causing FE.
  • Recent advancements in diagnostic techniques are improving the detection and management of FE.

Purpose of the Study:

  • To review the current understanding of fungal endophthalmitis (FE) etiology, diagnosis, and treatment.
  • To highlight the evolving role of molecular diagnostics and newer antifungal agents in managing FE.
  • To emphasize the importance of geographical context in FE epidemiology.

Main Methods:

  • Review of recent large case series on fungal endophthalmitis.
  • Discussion of diagnostic modalities including polymerase chain reaction (PCR), next-generation sequencing, galactomannan, and beta-D-glucan assays.
  • Analysis of emerging treatment strategies involving newer antifungal agents.

Main Results:

  • Molds, particularly Aspergillus, are the most common causes of FE, with Fusarium prevalent in keratitis-related cases.
  • Candida species are the primary agents in endogenous FE.
  • Polymerase chain reaction (PCR) offers high sensitivity for FE diagnosis, with costs decreasing and newer methods like next-generation sequencing addressing its limitations.

Conclusions:

  • Accurate diagnosis of FE relies on understanding geographical variations in fungal prevalence and utilizing advanced molecular techniques.
  • Emerging diagnostic tools and antifungal therapies show promise, though challenges like echinocandin vitreous penetration remain.
  • Continued research into novel diagnostics and treatments is crucial for improving outcomes in fungal endophthalmitis.
Keywords:
fungal endophthalmitisintravitreal injectionnext generation sequencingpars plana vitrectomypolymerase chain reaction

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