Ophthalmologic Evaluation and Clinical Outcome in Candidemia: A 7-Year Retrospective Multicenter Cohort Study

Ocular candidiasis (OC) is a notorious complication of candidemia, but guidelines on fundoscopic screening are inconsistent. We aimed to determine the frequency of OC in patients with candidemia who underwent fundoscopy, regardless of visual symptoms, and to evaluate its impact on antifungal treatment selection and duration.

A retrospective cohort study was performed at 2 tertiary care hospitals in the Netherlands in adult patients with at least 1 positive blood culture with Candida species between January 2018 and December 2024. Primary outcomes were the incidence of OC (defined as proven or probable chorioretinitis or endophthalmitis), persistent vision loss, and changes in the choice and/or duration of antifungal therapy in patients with OC.

Of 402 patients, 307 (76.4%) underwent fundoscopy. Ocular candidiasis was diagnosed in 15 of 307 patients (4.9%), including 12 with probable chorioretinitis (3.9%) and 3 with probable endophthalmitis (1.0%). Nine of the 15 patients (60%) were asymptomatic (n = 6) or unable to report symptoms (n = 3). In all 15 patients, the fundoscopic findings resulted in a change in therapy. This consisted of therapy prolongation (n = 15), addition of (n = 7) or switch to (n = 4) an azole, and intravitreal antifungal injections (n = 2). Persistent visual impairment of any degree occurred in 3 of 15 patients (20%), all of whom were initially symptomatic.

Ocular candidiasis is a relatively rare but clinically significant complication of candidemia. Fundoscopic findings are used to guide treatment decisions. Persistent vision loss was uncommon.