Endogenous Aspergillus endophthalmitis complicated by florid retinal neovascularization: double trouble

To describe the presentation, clinical course, and management of a patient with endogenous Aspergillus endophthalmitis complicated by florid retinal neovascularization.

A 32-year-old immunocompetent female developed a loss of vision in the right eye one week after receiving intravenous dextrose infusions in a local healthcare setting. Ocular examination revealed dense vitreous exudates for which an urgent vitrectomy was performed, with a presumptive diagnosis of endogenous endophthalmitis. Microbiological analysis of vitreous samples revealed Aspergillus flavus.

Intravitreal and oral antifungals lead to the resolution of inflammation. However, the patient soon presented with large neovascular fronds involving the disc and posterior pole, rapidly progressing to tractional retinal detachment involving the macula. The intravitreal anti-vascular endothelial growth factor (anti-VEGF) ranibizumab was injected, followed by repeat vitrectomy and membrane dissection with gas tamponade. This resulted in a satisfactory anatomical outcome but poor visual gain due to submacular scarring.

Endogenous Aspergillus endophthalmitis warrants early diagnosis and aggressive management to avoid complications such as ocular neovascularization, retinal detachment, and phthisis bulbi. Retinal neovascularization in endogenous endophthalmitis is a rarely observed finding, but if present, it indicates severe ongoing inflammation or underlying retinal ischemia.