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The American Academy of Ophthalmology evaluated the practice of routine screening for intraocular infection from Candida septicemia. In the United States, ophthalmologists are consulted in the hospital to screen for intraocular infection routinely for patients with Candida bloodstream infections. This practice was established in the era before the use of systemic antifungal medication and the establishment of definitions of ocular disease with candidemia. A recent systematic review found a rate of less than 1% of routinely screened patients with endophthalmitis from Candida septicemia. Other studies found higher rates of endophthalmitis but had limitations in terms of inaccuracies in ocular disease classification, lack of vitreous biopsies, selection biases, and lack of longer-term visual outcomes. Some studies attributed ocular findings to Candida infections, rather than other comorbidities. Studies also have not demonstrated differences in medical management that are modified for eye disease treatment; therefore, therapy should be dictated by the underlying Candida infection, rather than be tailored on the basis of ocular findings. In summary, the Academy does not recommend a routine ophthalmologic consultation after laboratory findings of systemic Candida septicemia, which appears to be a low-value practice. An ophthalmologic consultation is a reasonable practice for a patient with signs or symptoms suggestive of ocular infection regardless of Candida septicemia.

We report a case of Candida glabrata endophthalmitis which was effectively treated by intravitreal liposomal amphotericin B (L-AMB) injection. A 72-year-old man was referred to our department for positive blood culture of Candida glabrata. First ophthalmologic examination revealed a chorioretinal lesion in left eye, and the patient was diagnosed as possible candida chorioretinitis. Despite systemic antifungal therapy, his chorioretinal lesion increased in both eyes and complicated by vitritis. Intravitreal administration of L-AMB was introduced for probable candida endophthalmitis. Finally, improvement of vitritis and regression of chorioretinal lesions were obtained by total of 9 times intravitreal injection. Our case suggests the safety and efficacy of intravitreal L-AMB injection for Candida glabrata endophthalmitis.

Significance This study aimed to highlight the association of stellate neuroretinitis occurring secondary to endogenous candidemia. Purpose We report an unusual presentation of endogenous Candida endophthalmitis as a stellate neuroretinitis in the setting of Cornelia de Lange syndrome. Case report A 34-month-old girl with severe Cornelia de Lange syndrome and a history of parenteral nutrition dependence requiring a chronic central venous catheter presented with bilateral endophthalmitis secondary to candidemia. In one eye, the endophthalmitis had the atypical presentation as a stellate neuroretinitis. Conclusions This case represents a unique association of stellate neuroretinitis secondary to Candida infection in a patient with Cornelia de Lange syndrome.

cited By 1; Purpose: Candida endophthalmitis represents a therapeutic challenge, considering the inability of many antifungals to achieve adequate concentrations in the vitreous. Intravitreal injection (IVI) of antifungals (amphotericin b deoxycholate or voriconazole) is therefore recommended. Whereas amphotericin b IVI is well documented, clinical data on voriconazole IVI are limited. Methods: This was a retrospective review IRB approved of patients receiving voriconazole IVI for Candida endophthalmitis. Complete ophthalmological examination was completed at baseline and during follow-up. Results: Five patients were treated with a mean four injections [range: 2–9] of voriconazole (100 µg/0.1 mL saline). Improvement of visual acuity and disappearance of signs of infection were obtained in all patients. Safety concern including photoreceptor toxicity was not attributed to voriconazole IVI. Conclusions: Voriconazole IVI demonstrated to be safe and led to a favorable clinical outcome. Thus, voriconazole IVI must be performed if Candida endophthalmitis is suspected to increase the chance of clinical success. © 2019, © 2019 Taylor & Francis Group, LLC.

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

A 62-year-old female diabetic recovered from COVID-19 pneumonia after receiving a prolonged course of steroids. She presented with a clinical picture of left-eye panuveitis with white cotton ball chorioretinal lesions and RAPD suggesting an optic neuropathy (VA HM). Diagnostic vitrectomy was performed to take samples for infective screen and to give intravitreal voriconazole empirically. Smear, culture, and PCR for viral DNA confirmed mixed infection of endogenous Candida endophthalmitis and incidental CMV infection. With further treatment, her corrected vision improved to 6/18 with regressing fungal lesions in serial fundus photographs. Prompt diagnosis and intervention preserved her vision and prevented potential life-threatening complications.

Candins are commonly used as initial therapy in patients with candidemia and are known to diffuse poorly into ocular tissue. The aim of our multicenter study was to assess whether eye involvement was more common in patients initially treated with echinocandins. We performed a post hoc analysis of a prospective, multicenter, population-based candidemic surveillance program implemented in Spain during 2010-2011 (CANDIPOP project). Eye involvement was detected in 13 of 168 patients with candidemia (7.7%) who underwent ophthalmoscopy. Two patients had endophthalmitis, while the remaining patients had chorioretinitis. The frequency of ocular candidiasis was similar in patients receiving initial therapy with candins (3/56; 5.4%) or with other regimens (10/112; 8.9%). At multivariate analysis, risk conditions for eye involvement were dialysis after candidemia (OR, 19.4; 95% CI, 1.7-218.4) and involvement of organs other than the eye (OR, 5.4; 95% CI, 1.1-25.7). In conclusion, eye involvement was not found to be more frequent in patients receiving initial therapy with echinocandins than in patients receiving other drugs.

Endogenous endophthalmitis is a serious sight-threatening ocular emergency that usually occurs in patients with serious underlying risk factors. In this report, we describe a case of endogenous Candida endophthalmitis following trans-urethral lithotripsy in an immunocompetent woman. In our case, the retinal lesion regressed completely and vision was restored. We discuss diagnostic procedures and management strategies in this article.

Severe acute pancreatitis (SAP) is a risk factor for candidemia. We report a case of candida endophthalmitis in a 67-year-old man who was admitted to a hospital due to SAP with poorly controlled diabetes. After treatment for SAP, he was diagnosed with candidemia and candida endophthalmitis. We chose appropriate antifungal agents based on the results of a bacterial culture test. After treatment, the disappearance of Candida albicans (C. albicans) from the blood stream was confirmed in blood cultures. In addition, exudative plaques consistent with a fungal infection disappeared. After a diagnosis of candidemia is made, it is important to administer appropriate antifungal therapy and perform frequent ophthalmologic examinations.

Endogenous candida endophthalmitis (ECE) being a rare entity can often be misdiagnosed particularly in a seropositive debilitated patient. Ocular syphilis may have protean clinical manifestations and may be difficult to diagnose in absence of typical clinical manifestations. A high index of suspicion based on the clinical picture and imaging features may aid in differentiating these clinical entities. We report a case of ECE in a diabetic patient with a positive syphilis serology, the co-existence of which posed a diagnostic dilemma. We discuss the pragmatic approach and management for such a perplexing scenario.

Purpose To report a case of endogenous Candida endophthalmitis that may cause catastrophic sight-threatening outcomes, after extracorporeal shock wave lithotripsy (ESWL) in a healthy woman. Case presentation A 32-year-old woman presented to the ophthalmology clinic with the symptom of blurred vision and floater in her right eye. She underwent ESWL for renal stone 1 week prior to her presentation. Fundus examination showed an elevated white lesion in para-fovea with fluffy border. Smear of diagnostic vitreous sampling showed pseudo-hypha and budding yeast. Systemic and immunologic and infectious workups were unremarkable. In our case, response to intravitreal and intravenous injection of amphotericin-B and oral fluconazole was dramatic. Six weeks after starting the treatment, infiltrative lesion completely disappeared. The authors review previous MEDLINE literature about this topic. Conclusion Endogenous Candida endophthalmitis following renal stone lithotripsy is a serious and rare intraocular infection that may happen in healthy individuals without any risk factors.

Die vorliegende Kasuistik beschreibt den sehr seltenen Fall eines Candida-Linsenabszesses bei einem Fruhgeborenen (Gestationsalter 24 Wochen). Direkt nach der Geburt war es zu einer Candida-Sepsis gekommen, die mit systemischer antimykotischer Therapie erfolgreich behandelt wurde. Die aktuelle Vorstellung im Alter von 6 Monaten erfolgte aufgrund einer weislichen Veranderung im Bereich der Pupille bei unauffalligem Allgemeinzustand. Die Narkoseuntersuchung ergab eine grauliche Pupillarmembran und dahinter weisliches Material in einer gequollenen Linse. Es erfolgte die Lensektomie. Der posteriore Glaskorper sowie der Fundus waren unauffallig. Mikrobiologisch wurde Candida albicans nachgewiesen. Bei Fruhgeborenen mit noch existenter Tunica vasculosa lentis kann es zu einer Keimverschleppung in die Linse kommen, die nach Ruckbildung der Tunica einer systemischen Therapie nicht zugangig ist und erst zeitversetzt klinisch in Form einer Abszessbildung manifest werden kann.

Purpose To investigate the clinical manifestations and the results of the management of endogenous candida endophthalmitis (ECE) at our hospital. Methods This study was a retrospective chart review conducted between September 2002 and September 2012. Results Our study included 24 eyes of 14 patients. The culture results revealed Candida albicans in 11 cases and Candida tropicalis in three cases. Diabetes mellitus, cancer, and intravenous catheter implantation were the most important risk factors for ECE. A systemic antifungal agent combined with intravitreal injection or vitrectomy was our method for treating these cases and the complications. The outcomes were generally poor, with a final visual acuity (VA) of better than 0.1 in 10 cases, counting finger to 0.1 in six cases, light perception to hand motion in six cases, and no light perception in two cases. Conclusion Unsatisfactory visual outcome in ECE is related to poor initial VA and complications. Early diagnosis and prompt treatment are necessary for these patients.

Fungal endophthalmitis is a sight-threatening disease most commonly caused by Candida species. Candida endophthalmitis can result most often from hematogenous dissemination. Even though the use of prophylactic systemic antifungal therapy decreases the prevalence of ocular involvement during fungemia, it is important to maintain a high index of suspicion of endogenous Candida ocular infection, particularly in immunocompromised or diabetic patients, those with indwelling catheter, or among intravenous drug users. The diagnosis of Candida endophthalmitis is mainly clinical, usually based on the appearance of typical fundus lesions. Early diagnosis and prompt management significantly affect the visual prognosis. This review highlights presentation, diagnosis, and management of Candida endophthalmitis in the era of new systemic antifungal agents.

To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model.Intravitreal 1 × 10Total clinical scores were significantly different between treatment groups and the control group (p0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin.This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

Two cases of bilateral endogenous candida endophthalmitis occurring after abdominal surgery are presented. The first patient was treated with intravenous amphotericin B followed by oral ketoconazole. The active chorioretinal lesions resolved in 4 weeks. Subretinal neovascularization with fibrous scarring developed in the right macula, and a hole developed in the left macula of this patient leading to impaired visual acuity of both his eyes. The second patient was first examined by an ophthalmologist 5 months after onset of the infection with simultaneous decrease of visual acuity. Five months earlier she had received a 2-week course of miconazole. Oral corticosteroids were administered for treatment of active chorioretinal lesions observed in both her eyes. Both chorioretinal lesions and vitreous opacities disappeared within a year without fibrous scarring. The visual acuity of the left eye improved from 0.5 (observed on first examination) to 1.0. The visual acuity of the right eye remained at the level of finger counting only.

Purpose: To evaluate the efficacy of newly developed antifungal agents caspofungin and voriconazole in Candida albicans endophthalmitis in rabbit eyes. Methods: Thirty New Zealand white rabbits were divided into four treatment groups and one control group. One eye of each rabbit was infected by inoculation of 1 x 10(4) CFU/ml of C. albicans. Seventy-two hours after the inoculation, caspofungin 100 mu g/0.1 ml in group 1 (n = 6), voriconazole 50 mu g/0.1 ml in group 2 (n = 6), amphotencin B 10 mu g/0.1 ml in group 3 (n = 6), itraconazole 10 mu g/0.1 ml in group 4 (n = 6), and 0.1 ml NaCl 0.9% in control group (n = 6) were injected into the vitreous cavity. Clinical and histopathologic examination scores and microbiological analysis of vitreous aspirates were compared. Results: There was statistically significant difference in the clinical scores, histopathologic scores, and mean CFU/ml between the treatment and control groups (p < 0.05). In caspofungin and voriconazole groups, histopathologic scores and mean CFU were lower than other treatment groups and control group. Conclusions: Intravitreal injection of caspofungin and voriconazole was effective against C. albicans endophthalmitis in this experimental rabbit model.

Fungus balls have been rarely implicated as a cause of urinary tract obstruction. Here, we report a case of Candida albicans fungus balls in the urinary tract after the treatment of Candida endophthalmitis that has enough periods and adequate amount of antifungal agents. The patient completely recovered from this rare complication by irrigating through single-J stent and changing antifungal agents. Here we emphasize that we should take into account not only the susceptibility test results but also the difference in excretion route and tissue distribution of antifungal agents.

PURPOSE To report the long-term visual and anatomical outcomes for patients treated with submacular surgery for choroidal neovascularization associated with endogenous candidal endophthalmitis. METHODS Review of the medical records, fluorescein angiograms, fundus photographs, and histopathologic specimens of patients treated with submacular surgery for choroidal neovascularization following candidal endophthalmitis. RESULTS This series included 3 patients (1 woman and 2 men) who were 26, 30, and 60 years of age. Each patient had received systemic antifungal treatment for culture-proven candidal septicemia before the development of choroidal neovascularization. Each patient had bilateral choroidal neovascularization diagnosed by biomicroscopic examination and angiographic appearance: 2 eyes had an active subfoveal membrane; 2, an active juxtafoveal subretinal membrane; and 2, a mixture of active subfoveal neovascularization with subfoveal fibrosis. Submacular surgery was performed on five eyes with choroidal neovascularization; one eye with subfoveal fibrosis was observed. Visual acuity improved substantially in 4 eyes of 3 patients treated with submacular surgery. Visual improvement was limited in the two eyes with preexisting submacular fibrosis. During 13-month to 82-month follow-ups, vision remained stable, with no recurrence of neovascularization. CONCLUSION Choroidal neovascularization can cause severe visual loss in patients with endogenous candidal infection. Submacular surgery with removal of choroidal neovascularization may restore vision in selected patients. Subfoveal fibrosis may limit visual improvement.

Purpose The purpose of this study is to report the use of spectral-domain optical coherence tomography in monitoring endogenous Candida endophthalmitis. Methods A patient diagnosed with candidemia was followed for endogenous Candida endophthalmitis. With each clinic visit, the patient underwent visual acuity assessment, slit-lamp biomicroscopy, dilated fundus examination, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography. Results At initial examination, the patient's visual acuity was 20/200 in both eyes. Creamy yellow fungal lesions were visualized within one disk diameter of the fovea and along the arcades. These lesions, in various stages of evolution, were imaged with spectral-domain optical coherence tomography, localizing their depth within the retina. Deeper retinal lesions corresponded to early active inflammatory lesions as confirmed by hypofluorescent areas with late staining on the fluorescein angiography. More superficial lesions on the vitreoretinal interface corresponded to late inactive lesions corresponding to blocked areas on the fluorescein angiography. After the resolution of most lesions, her final visual acuity was 20/25 in both eyes at last follow-up. Conclusion The depth of lesions as shown by the spectral-domain optical coherence tomography corresponds to various stages of fungal infection, allowing clinicians to monitor the disease and its response to therapy.

Candida endophthalmitis is a common cause of fungal endophthalmitis. A case of bilateral endogenous endophthalmitis caused by Candida albicans without candidemia in an otherwise healthy 77-year-old man was reported. The patient underwent bilateral pars plana vitrectomy and intravitreal liposomal amphotericin B injections in addition to systemic fluconazole therapy. Postoperatively, a significant decrease of inflammation and resolution of abscesses were observed in both eyes. Vision improved in the left eye but remained constant in the right eye because of secondary cataract formation. To the best of our knowledge, this is the first report on the use of liposomal amphotericin B intravitreally in a patient with bilateral endogenous candida endophthalmitis. No evidence of clinical ocular toxicity was observed with the liposomal form of amphotericin B injection.

Aims/Background: We evaluated the retinal toxicity of spartanamicin B and its efficacy in a rabbit model of Candidal endophthalmitis. Methods: Toxicity. Fourteen albino rabbit eyes were injected intravitreally with spartanamicin B (1, 2, 5, 10, 25, 50, and 100 μg) ; 2 eyes received the vehicle alone. Efficacy. Ten rabbit eyes were inoculated with 3000 Candida organisms which caused endophthalmitis in 24 hours. Eight eyes were treated with intravitreal spartanamicin B in doses of 1, 2, 5, or 10 μg/0.1 ml; 2 untreated eyes served as controls. Results: Toxicity. The eyes injected with ≤ 10 μg and the control group eyes exhibited no clinical, histological, or electroretinographic evidence of retinal toxicity. Doses > 10 μg caused vitritis. Efficacy. Clinical examination of the treated eyes showed a gradual improvement over 3–6 days; mild opacities remained until day 14. Results of cultures performed 15 days after infection were negative in all treated eyes. Conclusions: Intravitreally injected spartanamicin B (10 μg) is nontoxic to the retina, effective against C. albicans in the endophthalmitis model in the rabbit eye and caused no discernible histological changes in the retina.

Eine 22jahrige Patientin zeigte nach intravenosem Heroinabusus das klinische Bild einer Candida-Endophthalmitis, obwohl die Blutkulturen, die Antigen- und Antikorperbestimmungen auf keine Infektion mit diesem Erreger hinwiesen. Eine intravenose Fluconazoltherapie fuhrte zu keiner Besserung der Symptome. Erst die Vitrektomie ermoglichte den Nachweis eines Candida albicans-Stammes, welcher gegen Fluconazol relativ resistent war. Die intravenose- und intravitreale Therapie mit Amphotericin B fuhrte zur vollstandigen Abheilung der retinalen Lasionen. Bei Candida-Endophthalmitis und Heroinabusus bietet die Antigen- und Antikorperbestimmung meist keine Hilfe zur Diagnosestellung und Verlaufskontrolle. Wenn das klinische Bild primar unklar ist oder der Therapieeffekt ungenugend ist, so ist die fruhe Indikation zur Vitrektomie zu stellen. A 22 year old patient presented with the clinical picture of Candida endophthalmitis after intravenous heroinabuse. Blood-cultures, antigens and antibodies of Candida albicans were negative. An intravenous fluconazole-therapy did not lead to any improvement of symptoms. Just vitrectomy and vitreous examinations proved the evidence of Candida albicans, which was relatively resistant to fluconazole. The intravenous- and intravitreal therapy with amphotericin B led to a complete scarring of the retinal lesions. In the case of Candida endophthalmitis and heroinabuse the antigen and antibody analysis offers almost no support to diagnosis and control of process. Early vitrectomy is indicated, if the clinical picture primary is unclear or if the efficiency of therapy is insufficient.

A bibliographic search was conducted of cases of Candida endophthalmitis reported in Japan and overseas between 2000 and 2011, in the Japana Centra Revuo Medicina Website of Japan Medical Abstracts Society (domestic reports) and MEDLINE (overseas reports). The investigation yielded 42 reports in domestic journals (49 cases ; hereinafter referred to as domestic cases) and 39 reports in journals published overseas (46 cases ; hereinafter referred to as overseas cases). The isolation rate of Candida albicans in the domestic cases was 65.3%, and that in the overseas cases was 71.7%. The initial treatment for the Candida endophthalmitis was fluconazole (FLCZ) therapy in 51.0% of the domestic cases and 38.1% of the overseas cases. Domestic reports suggested the effectiveness of FLCZ therapy for stage II cases, and of vitrectomy for stage III and IV cases. Reports from overseas, on the other hand, suggested the effectiveness of amphotericin B (AMPH-B) or voriconazole (VRCZ) therapy for stage II cases, and of vitrectomy for stage III and IV cases.

経中心静脈高カロリー輸液法(intravenous hyperalimentation,以下IVHと略す)施行中にカンジダ性眼内炎が発症した2症例を報告した.症例1;39歳,男性.亜急性硬膜外血腫の手術後IVH施行中に両眼の飛蚊症,霧視や視力低下が出現し,さらに心窩部に小豆大の腫瘤を伴うカンジダ性皮下膿瘍を併発した.症例2;59歳,男性.胃癌手術後IVH施行中に両眼の視力低下が生じた.2症例とも手術後合併症のため約1ヵ月間のIVH管理下にあり長期のIVHの使用と抗生物質の投与が主たる誘因と考えられた.切除された硝子体や眼内潅流液及び症例1の心窩部の皮下膿瘍からカンジダが純培養された.両症例とも硝子体切除術と抗真菌剤の硝子体内への注入と全身投与で治癒したが切除術を行う時期や適応に若干検討の余地があると考えられた.

Endogenous infantile Candida endophthalmitis is a rare but potentially devastating condition resulting from sequestration of the fungus within the lens after systemic infection. We report the case of a 20-week-old girl with a history of Candida sepsis who presented with bilateral Candida albicans endophthalmitis 15 weeks after completing a 6-week course of intravenous antifungal therapy. Prompt vitrectomy resulted in salvage of the right eye, although a total retinal detachment occurred. Cataract extraction and administration of intravenous and intravitreal amphotericin B preserved vision in the left eye.

Bilateral endogenous Candida endophthalmitis as the presenting manifestation of diabetes mellitus

Endogenous Candida endophthalmitis is a well-recognized complication in low-birth-weight premature infants. 1 The incidence of systemic candidiasis in premature and low-birth-weight infants is approximately 3%. 1-5 As many as half of these infants will develop Candida endophthalmitis. 1 Eye involvement typically presents as one or more tiny white "fungal ball" chorioretinal lesions with overlying vitritis. 1,6,7 Lens involvement is extremely rare. 8 We report a case of cataract due to Candida albicans in a premature, low-birth-weight infant unresponsive to systemic and intracameral antifungal therapy and requiring lensectomy with vitrectomy. J AAPOS 2000;4:386-8.

In the March 1981 issue of the Journal of Pediatrics, Baley, Annable and Kleigman discussed the natural course of Candida endophthalmitis in the premature infant. We now have long-term follow-up on the three surviving infants along with follow-up on an additional eight patients. Though vitrectomy is routinely performed in adults, we recommended that it not be performed in premature infants with systemic candidiasis and associated vitreo-retinal pathology. These 1 1 infants with candidal endophthalmitis secondary to systemic candidiasis demonstrated minimal residual ocular pathology after having been treated with systemic antifungals alone. Neither vitreous taps nor intravitreal injections should be performed in infants with ocular candidiasis.

PURPOSE. To evaluate the effects on visual function and choroidal neovascularization (CNV) progression in a case of subretinal CNV due to Candida endophthalmitis treated with a combination of photodynamic therapy (PDT) and drugs. METHODS. A 28-year-old one-eyed woman with CNV in the right eye came to our observation. The CNV developed as a consequence of Candida endophthalmitis. The CNV was treated with six PDT treatments with verteporfin in association with systemic steroid therapy with prednisone (100 mg/day to reduce) and fluconazole (800 mg/day to reduce). Visual acuity (VA) was assessed in pre-PDT conditions and after six PDT treatments (24 months of follow-up). RESULTS. Pre-PDT VA was 20/125; after 24 months of follow-up, six PDT re-treatments, and pharmacologic therapy, VA was stabilized at 20/100. CONCLUSIONS. In our case, associated PDT and drug therapies were safe and useful to maintain VA and to arrest CNV progression in the foveal region after 2 years of follow-up. (Eur J Ophthalmol 2007; 17: 124-7)

Consecutive keratitis and candida endophthalmitis in an immunocompromised patient with chronic lymphocytic leukaemia

Candidiasis has emerged as the most common opportunistic fungal disease over recent decades owing to the progressively increasing use of antibiotics, immunosuppressive and cytotoxic drugs, indwelling foreign bodies and organ transplantation. Hematogenous candida endophthalmitis, which has a characteristic finding of single or multiple fluffy white cotton ball-like chorioretinal lesions often extending into vitreous, is the most fulminant manifestation of systemic candidiasis and may result in blindness. These ocular lesions can be easily recognized on funduscopic examination and should be serially looked for in all patients with known and suspected systemic candidiasis. We report hematogenous candida endophthalmitis in a patient of systemic candidiasis and, to our knowledge, it is the first reported case in our country.

To report the first case of Candida albicans endophthalmitis following penetrating keratoplasty after warm preservation.Observational case report.We reviewed the patient's chart and the available literature on fungal endophthalmitis after keratoplasty.After keratoplasty, a 45-year-old man developed an endophthalmitis on the first postoperative day. The same day, results of the culture of the transportation medium were available and revealed Candida albicans. Despite therapy with topical and subtenon amphotericin B, there was no clinical improvement, and a regraft was performed 4 days after the initial corneal transplant. A best corrected visual acuity of 20/32 was achieved.The majority of reported cases of postkeratoplasty candidal endophthalmitis are associated with cold storage preservation and a poor prognosis of the affected eye. We describe a case of postkeratoplasty candidal endophthalmitis after organ-cultured preservation, with a final visual acuity above expectations. In our opinion, early diagnosis based on routine culturing of the transportation medium and early removal of the infected corneal graft when local antifungal therapy failed are important factors contributing to the good clinical outcome.

The Centers for Disease Control and Prevention recently reported that a substantial number of drug misusers in the US are injecting crack-cocaine instead of smoking it,1 owing to the decreased availability and increased cost of powdered cocaine. The use of lemon juice to dissolve crack-cocaine has been shown to cause abscesses, permanent vein damage and infections.2 Furthermore, heroin dissolved in preserved lemon juice was documented to be a source of Candida albicans in multiple, small epidemics of fungal endophthalmitis in the 1980s in the UK and Australia.3,4 We report here two recent cases of fungal endophthalmitis in crack users who similarly disclose dissolving crack-cocaine in lemon juice injection. A 34-year-old male intravenous drug user presented to his primary care physician with high fever …

Purpose We treated five patients who had ocular fungal infections with oral fluconazole to determine its safety and effectiveness. Methods We reviewed the case histories of the five patients. One patient had coccidioidomycosis and four had endogenous Candida endophthalmitis. Results The intraocular fungal infection resolved in all patients. Conclusion Fluconazole appears to be a safe and effective antifungal agent that can be administered orally and may be a useful agent for treating some intraocular fungal infections.