[Anatomo-clinical and therapeutic aspects of Candida albicans endophthalmitis]

Endophthalmia due to Candida has increased in incidence over the last few years, particularly in drug addicts. Two cases of severe bilateral Candida albicans endophthalmia are reported. Histological examination of the globes following treatment by amphotericin B i.v. and secondary vitrectomy demonstrated persistence of Candida, particularly in the preretinal membrane, in the first case. Treatment in the second case consisted of amphotericin B i.v. and 5 fluorocytosine, associated with vitrectomy and an intravitreal injection of 5 micrograms of amphotericin B. Fungal elements were absent on histological examination of the globes. Ocular Candida albicans lesions may be of exogenous origin but contamination arises more frequently from an endogenous source. The resulting endophthalmia leads to retinal nodules having a tendency to extend into the vitreous. Clinical features are fairly typical and diagnosis not a problem. General treatment consists of combined administration of amphotericin B and 5 fluorocytosine, but results are often disappointing as effective penetration of these compounds into the intraocular zone is not obtained. Early vitrectomy, when a vitreal lesion exists, offers many advantages such as the possibility to identify Candida in the removed aqueous humor. As histological examination shows persistence of Candida in the preretinal membrane, the vitrectomy should be combined with intravitreal injections of amphotericin B.