Aspergillus endophthalmitis early post-phacoemulsification: a case of failed salvage

This study aims to document a rare and aggressive instance of Aspergillus endophthalmitis following phacoemulsification, emphasizing the diagnostic complexities, therapeutic constraints, and clinical prognosis associated with this condition.

A 76-year-old male patient presented to our institution on postoperative day 5 (POD 5) following cataract surgery, manifesting acute-onset right ocular pain accompanied by substantial visual impairment that had developed on POD 4. Comprehensive clinical evaluation revealed severe anterior chamber inflammation, hypopyon, and vitreous haze. An emergency pars plana vitrectomy was performed, accompanied by scleral-fixated intraocular lens (IOL) implantation. Vitreous samples were collected for microbiological analysis.

Microbiological culture of the vitreous specimen confirmed the presence of Aspergillus species. The patient was subsequently treated with a multimodal antifungal regimen, including systemic voriconazole, intracameral irrigations, and topical antifungal agents. Despite these aggressive therapeutic measures, the infection progressed to no light perception vision, necessitating enucleation due to unrelenting pain and inflammation. Histopathological examination revealed extensive necrotic inflammatory changes.

This case highlights the aggressive pathogenesis of Aspergillus endophthalmitis, its limited responsiveness to conventional therapeutic interventions, and the critical importance of early suspicion of fungal etiology in postoperative infections.