Candida pelliculosa cluster endophthalmitis: clinical profile and surgical outcomes in twelve eyes

To describe the clinical features and surgical outcomes of Candida pelliculosa cluster endophthalmitis following cataract surgery.

Twelve eyes of ten patients developed endophthalmitis after uncomplicated phacoemulsification with intraocular lens (IOL) implantation performed at a single hospital. All underwent core vitrectomy, IOL explantation, and intravitreal injections of vancomycin, ceftazidime, and voriconazole. Explanted IOL-bag complexes and vitreous samples were analyzed microbiologically. Secondary scleral-fixated IOL (SFIOL) implantation was performed after disease quiescence. Minimum follow-up was three months.

The mean interval from cataract surgery to presentation was 28 days. Presenting symptoms included pain, redness, and mild vision loss. Mean presenting BCVA was 20/40 (0.3 LogMAR). All eyes showed mild congestion, keratic precipitates, fluffy capsular plaques, IOL deposits, and vitritis; three had corneal tunnel infiltrates and two had "string of pearls." Candida pelliculosa was isolated from all explanted IOL-bag complexes, while vitreous cultures were negative. All lenses were monofocal and from the same manufacturer. Mean post-vitrectomy BCVA was 20/60 (0.48 LogMAR; p = 0.718). Five eyes developed cystoid macular edema, one required sub-Tenon triamcinolone, and four developed epiretinal membranes. After a mean of 5.2 months, seven eyes underwent SFIOL implantation, achieving a final BCVA of 20/32 (p = 0.33).

This first reported series of postoperative Candida pelliculosa cluster endophthalmitis underscores its subtle presentation and delayed onset. Early vitrectomy with IOL-bag explantation ensures infection control and favorable visual recovery.