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Published on: February 6, 2021
Exogenous Fusarium Endophthalmitis: Clinical Features, Treatment Modalities, and Visual Outcomes
Sujin Kang1, William E Smiddy1, Nicolas A Yannuzzi1
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States.
Purpose:
To characterize the clinical features, treatment modalities, and visual outcomes of culture-proven exogenous Fusarium endophthalmitis managed at a tertiary referral center.
Methods:
This retrospective, single-center, consecutive case series included 14 eyes of 14 patients with culture-proven exogenous Fusarium endophthalmitis treated between October 2014 and December 2025. Diagnosis was confirmed by positive intraocular (aqueous or vitreous) cultures. Clinical records were reviewed for demographics, presenting characteristics, treatment course, complications, and visual and intraocular pressure outcomes.
Results:
Median presenting best-corrected visual acuity (BCVA) was 2.40 logMAR (∼20/5000). Infection sources included trauma (7/14, 50%), anterior segment surgery (5/14, 36%), and contact lens-associated fungal keratitis (2/14, 14%). All eyes required combined antifungal therapy (topical, intravitreal, intracameral, and/or intrastromal with systemic treatment) and surgical intervention, including therapeutic penetrating keratoplasty (14/14, 100%) and vitrectomy (8/14, 57%). Median follow-up was 594 days. Median BCVA at last follow-up remained poor at 2.25 logMAR (∼20/3600), with four of 14 patients (29%) achieving ≥20/400 vision and three of 14 patients (21%) having light perception or no light perception. Complications occurred in 10 of 14 eyes (71%), most commonly ocular hypertension or secondary glaucoma (8/10, 80%) and retinal detachment (3/10, 30%). No eyes required enucleation or evisceration.
Conclusions:
Exogenous Fusarium endophthalmitis is a serious ocular infection requiring multimodal therapy and multiple surgical interventions, yet long-term visual outcomes remain poor. Early fungal recognition and prompt antifungal treatment may improve outcome.
Insights
Exogenous Fusarium endophthalmitis is a severe eye infection that often leads to poor vision despite aggressive treatment. Early detection and prompt antifungal therapy are crucial for improving outcomes in these challenging cases.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Exogenous Fusarium endophthalmitis is a rare but devastating intraocular infection.
- Prompt diagnosis and treatment are critical for visual preservation.
Purpose of the Study:
- To analyze the clinical characteristics, treatment strategies, and visual results of Fusarium endophthalmitis.
- To evaluate outcomes in patients managed at a tertiary care center.
Main Methods:
- Retrospective case series of 14 eyes with culture-proven Fusarium endophthalmitis.
- Review of clinical data including demographics, presentation, treatment, and outcomes.
- Analysis of visual acuity, intraocular pressure, and complications.
Main Results:
- Infection sources included trauma, surgery, and contact lens use.
- All patients required combined medical and surgical antifungal treatment.
- Poor visual outcomes were common, with a median BCVA of 2.25 logMAR at follow-up.
- Complications such as glaucoma and retinal detachment occurred frequently.
Conclusions:
- Fusarium endophthalmitis necessitates aggressive, multimodal treatment with significant surgical intervention.
- Long-term visual prognosis remains guarded despite comprehensive management.
- Emphasizing early recognition and timely antifungal intervention is vital.
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