[Favorable development of bilateral Candida albicans endophthalmitis. Value of early vitrectomy]

A chronic bilateral endogenous Candida albicans endophthalmitis in a heroin addict was treated by vitrectomy, argon laser photocoagulation and endodiathermy. In the left eye with a visual acuity of 6/6 there was a totally asymptomatic retinal tear due to vitreous traction. The eye was treated by argon laser photocoagulation immediately, and then underwent a vitrectomy several weeks later. Analysis of the vitrectomy specimen was negative for any organism. In the vitreous of the right eye a "fungus ball" was noted nasally. Visual acuity was also 6/6. Fluorescein angiography demonstrated the presence of a small area of retinal involvement above the optic disc. During vitrectomy and membrane peeling the area of retinal involvement was torn away. The tear was then treated by endodiathermy. Vitreous analysis showed the presence of Candida albicans, sensitive to 5-fluorocytosine which was then used in treatment. All other cultures and stains were negative for Candida. The patient had negative serology for Candida, but normal immune responses based on cutaneous testing to several antigens and dosage of serum immunoglobulins and complement. A negative serology to Candida is most likely explained by the supposition that an episode of blood stream infection occurred only briefly and long before the eye involvement became clinically significant. At 4 months after bilateral vitrectomy, the patient has maintained 6/6 vision in each eye.