Exogenous Fungal Endophthalmitis: A 20-Year Experience at a Tertiary Referral Centre in North China.

Purpose: To report the epidemiological characteristics, causative pathogens, treatment approaches, and outcomes of culture-proven exogenous fungal endophthalmitis (EFE).

Methods: This retrospective, interventional case series analysed the data of 112 patients with culture-positive EFE treated at a tertiary centre in North China between 2001 and 2020. The medical data of patients were extracted from hospital records.

Results: EFE was associated with fungal keratitis, penetrating trauma, and intraocular surgery in 67 (59.8%), 39 (34.8%), and six eyes (5.4%), respectively. The primary cause of infection was mould (106/112, 94.6%), followed by yeast infection (6/112, 5.4%). Most keratitis cases were caused by Fusarium (32/67, 47.8%). Moreover, Aspergillus was the predominant species associated with penetrating trauma (15/39, 38.5%). Furthermore, Fusarium accounted for 50% (3/6) of postoperative cases. More than half of the eyes (89/112, 79.5%) were preserved through penetrating keratoplasty, vitrectomy, or intravitreal antifungal injections. However, 23 eyes (20.5%) were eviscerated, including 16 with fungal keratitis and seven with penetrating trauma.

Conclusion: Fusarium and Aspergillus were the predominant pathogens in EFE, with fungal keratitis as the leading cause. Visual prognosis varied, with keratitis-associated cases showing the poorest outcomes, underscoring the need for early diagnosis and timely intervention.