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Purpose: To evaluate factors that inform systemic antifungal choices in patients with endogenous fungal endophthalmitis (EFE)., Design: Single-institution retrospective case series., Methods: Charts of EFE patients from 2010 to 2023 were reviewed. Patients treated systemically for EFE with a minimum of 14 days of follow-up were included. Outcome measures included time to improvement in vitritis or chorioretinitis, systemic therapy modification, and need for surgical intervention., Results: A total of 20 eyes of 16 patients were included. Candida species were most common (43.8%), followed by culture-negative EFE (37.5%) and Aspergillus species (18.8%). In all, 90% of eyes had vitritis and/or macula-involving chorioretinitis. The majority of Candida infections (60%) or culture-negative EFE (75%) were treated initially with oral antifungals. Patients with a history of immune compromise, positive fungal culture, or positive Fungitell assay were more likely to be treated with early intravenous (IV) antifungal therapy. Two patients required systemic antifungal therapy modification because of worsening chorioretinitis, in 1 case due to voriconazole-resistant Aspergillosis that demonstrated chorioretinal lesion growth despite intravitreal amphotericin B injections and systemic voriconazole, and in the second case due to worsening chorioretinitis from Candida dubliniensis infection that regressed upon switch from oral to IV fluconazole., Conclusions: Initial systemic treatment decisions in patients with EFE were driven by systemic culture positivity, systemic symptoms, or comorbidities. Intravitreal antifungal therapy may be insufficient to arrest progression of chorioretinal lesions in some cases. Larger studies are needed to determine whether visible end-organ damage in the form of chorioretinitis may be useful for guiding systemic therapy changes., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To report a case of bilateral endogenous fungal endophthalmitis resulting from disseminated Scedosporium prolificans., Design: Observational case report., Methods: A 56-year-old woman with cystic fibrosis status post dual lung transplantation on chronic immunosuppressive therapy presented with acute graft rejection. Cultures of bronchial brushings revealed S. prolificans. Three weeks after admission, the patient noted increased blurriness and a central scotoma in her right eye. Dilated fundus examination revealed profound vitritis in the right eye with hemorrhagic retinitis involving the macula. A peripheral, yellow choroidal infiltrate with overlying retinitis and localized vitritis was present in the left eye., Results: Intravitreal antibiotics were initiated, and vitreous cultures revealed S. prolificans. The patient ultimately succumbed to her disseminated disease. Pathologic examination of the eyes confirmed bilateral endogenous fungal endophthalmitis., Conclusion: S. prolificans is an opportunistic infection resistant to standard antifungal therapy that can result in endogenous endophthalmitis in immunocompromised individuals.

Purpose: To evaluate ocular findings in hospitalized children with systemic Candida species infection., Design: Retrospective review of inpatient hospital consultations., Method: Inpatient hospital consultations performed by a pediatric ophthalmology service over a 30-month period were reviewed., Results: Of 600 consultations performed by the service, 30 were to rule out ocular findings in patients with suspected or known candida infection. No patients had ocular findings consistent with endophthalmitis or chorioretinitis. One patient had nonspecific findings of multisystem organ failure, and one had vascular findings secondary to elevated pulmonary venous pressures., Conclusions: In contrast to the results of studies performed 10 to 15 years ago, ocular involvement is highly unusual in children with candidemia, but such consultations account for a substantial workload. Further attention to risk factors associated with ocular infection is warranted.

Purpose: To determine choroidal involvement in presumed tuberculous posterior uveitis by examining indocyanine green angiographic features., Methods: Indocyanine green angiography was performed according to a standard uveitis angiographic protocol in eight consecutive patients (15 eyes) with presumed posterior tuberculous uveitis., Results: In 100% of the 15 examined eyes, indocyanine green angiography disclosed choroidal lesions that were subclinical, not detected by fundus examination or fluorescein angiography, in six (40%) of 15 eyes. Findings were classified into four main angiographic signs: (1) irregularly distributed, hypofluorescent areas in the early and intermediate phases of angiography that either became isofluorescent (type 1 hypofluorescence) or remained hypofluorescent (type 2 hypofluorescence) in the late phase; (2) numerous, small, focal, hyperfluorescent spots; (3) choroidal vessels that appeared fuzzy in the intermediate phase because of leakage, leading in the late phase to (4) diffuse choroidal hyperfluorescence. Type 1 hypofluorescent lesions, fuzzy choroidal vessels, and diffuse choroidal hyperfluorescence tended to regress after the initiation of antituberculous and corticosteroid treatment. Focal hyperfluorescence tended to be associated with longstanding disease., Conclusions: Indocyanine green angiography was useful in assessing and quantifying the as yet unknown extent of choroidal involvement in tuberculous posterior uveitis. Its characteristic appearance may be a valuable contribution to the diagnosis and monitoring of treatment response.

Purpose: To study the clinical histories and courses of six patients with choroidal neovascularization secondary to endogenous Candida albicans chorioretinitis., Methods: The medical records, fundus photographs, and fluorescein angiograms of six patients who developed C. albicans chorioretinitis secondary to candidemia and who subsequently developed choroidal neovascularization in one or both eyes were reviewed., Results: The six patients ranged in age from 18 to 79 years. Four were women and two men; all but one showed evidence of bilateral chorioretinal scarring secondary to C. albicans chorioretinitis. All patients had been treated successfully with systemic antifungal therapy (amphotericin B). Two weeks to two years after the chorioretinitis, choroidal neovascularization developed in one eye (four cases) or both eyes (two cases). The neovascularization on initial examination was subfoveal in four eyes, extrafoveal in three eyes, and juxtafoveal in one eye. Laser photocoagulation was used in four of the eight involved eyes. In these cases, the active choroidal neovascularization was brought under control. In one eye, the patient had submacular surgery for excision of the choroidal neovascular membrane. Final visual acuities ranged from 20/20 to 20/200 in treated eyes and from 20/50 to 20/400 in untreated eyes., Conclusion: Choroidal neovascularization is a potential cause of late visual loss in patients who have had C. albicans sepsis and endogenous C. albicans chorioretinitis. Eyes that have chorioretinal scarring from C. albicans chorioretinitis should be watched for the development of choroidal neovascularization. Laser photocoagulation or perhaps surgical excision of the neovascular complex may be of benefit in selected cases.

Purpose: To elucidate a case of tuberculous choroiditis in a patient with the acquired immunodeficiency syndrome (AIDS)., Methods: We treated a 35-year-old woman who had AIDS with neurologic involvement caused by Mycobacterium tuberculosis. She developed a yellow-white chorioretinal infiltrate with indistinct borders and mild vitreitis in the right eye, probably caused by this pathogen., Results: The patient's visual acuity improved in the right eye with healing of the ocular lesion and her neurologic condition improved after specific therapy with isoniazid, rifampin, and ethambutol., Conclusion: Tuberculosis must be considered in the differential diagnosis of posterior uveitis and choroiditis in AIDS patients.

A previously healthy 20-year-old man developed bilateral chorioretinitis that included mild anterior uveitis, vitreous cells, multifocal chorioretinitis, and optic nerve swelling that progressed to severe optic neuropathy in one eye. Chorioretinal biopsy specimens cultured herpes simplex type 1 from separate chorioretinal and vitreous samples. Although the visual acuity of one eye remained at light perception, sight in the second eye was saved when treatment with systemic acyclovir and corticosteroids led to resolution of the inflammation. A recurrence was successfully treated with acyclovir alone and the patient shows no evidence of active disease.

Cytomegalovirus (CMV) was recovered from the tears in eight of 41 (19.5%) children excreting CMV in their urine or saliva. Tear excretors were all immunosuppressed children with acute lymphocytic leukemia. Three had active CMV chorioretinitis and five did not develop retinal disease in nine to 15 months of observation. To our knowledge this was the first report of the recovery of CMV from tears and of acquired CMV chorioretinitis in children. One patient with active chorioretinitis presented with a disciform elevation of the macula. Therapy with adenine arabinoside (ara-A) or idoxuridine was ineffective in two patients while a third patient treated with ara-Apossibly had a more rapid recovery. However, the significance is uncertain due to the unusual disease presentation and lack of data regarding the nature of cytomegalic inclusion disease chorioretinitis. Areas of retinal calcification were present at autopsy in one patient.

A 40-year-old man developed obstructive hydrocephalus of uncertain cause followed by bilateral intraocular inflammation, which was initially diagnosed as toxoplasmic retinochoroiditis. When visual acuity in the left eye decreased to no light perception and vision in the right eye was failing, a diagnostic enucleation of the blind left eye was performed. A diagnosis of cryptococcal endophthalmitis was established and the remaining right eye showed improvement after systemic anticryptococcal therapy.