Clinical Features, Management Strategies, and Visual Acuity Outcomes of Candida Endophthalmitis Following Cataract Surgery

BACKGROUND AND OBJECTIVE: To report the clinical features, management, and visual outcome in patients with Candida endophthalmitis following cataract surgery. PATIENTS AND METHODS: The Bascom Palmer Eye Institute Microbiology Laboratory database and corresponding medical records were reviewed from 1980 to 2006. RESULTS: Five patients were identified. Endophthalmitis developed 7 to 60 days postoperatively (median, 14 days). Presenting visual acuity was 20/200 to counting fingers and final visual acuity was 20/25 to light perception. Whitish material was noted on the intraocular lens or lens capsule (4 of 5) or within the cataract wound (1 of 5). All patients received intravitreal amphotericin B and more than one pars plana vitrectomy procedure; four received systemic antifungal agents and four underwent intraocular lens removal. CONCLUSIONS: Given whitish material on the intraocular lens, lens capsule, or cataract wound, Candida should be included in the differential diagnosis of early- or delayed-onset endophthalmitis following cataract surgery. Initial pars plana vitrectomy and intravitreal and oral antifungal medications may not achieve infection resolution. Intraocular lens explantation may assist in organism eradication.