Endogenous Aspergillus endophthalmitis -: Report of 3 cases and review of the literature

We reviewed 86 cases of endogenous Aspergillus endophthalmitis reported since 1949. Predisposing medical conditions were present in 94%. Intravenous drug use was noted in 27%, solid organ transplantation in 23%, underlying lung disease in 17%, and 43% had received corticosteroids. The predominant organism causing endophthalmitis was A. fumigatus (51% of cultures). However, 26% of patients had A. flavus isolated. This species was strongly linked to the use of intravenous drugs. Of the 18 patients with endophthalmitis due to A. flavus, 14 (78%) were intravenous drug users. The diagnosis of endogenous Aspergillus endophthalmitis is difficult and frequently made only at autopsy. Pars plana vitrectomy appears to be the highest-yield procedure for establishing the diagnosis; 90% of vitrectomy specimens yielded Aspergillus compared with 50% of vitreous aspirates. Outcomes were generally poor; only 7 of the 84 patients (8%) with posterior chamber involvement regained useful vision. Treatment with intravenous amphotericin B combined with intravitreal injection of amphotericin B and vitrectomy appears to be the most efficacious therapy. Six of the 7 patients reported to have regained useful vision had received such treatment.