Aggressive Surgical Management for Acute Neonatal Endogenous Candida Endophthalmitis with Persistent Fetal Vasculature and Pars Plana Granuloma.

Purpose: To report aggressive surgical management for bilateral acute neonatal endogenous Candida endophthalmitis in the different presenting spectrums of the disease.

Methods: Ultra-widefield fundus photo documentation for both eyes at presentation and after the surgical procedure. Surgical video with stepwise precautions while performing the procedure of pars plana lensectomy for lens abscess, vitrectomy for vitreous exudates, and cryotherapy for fungal granuloma in neonatal endogenous endophthalmitis.

Results: A 2-month-old baby with a history of premature birth was referred to our hospital by the treating pediatrician with a clinical suspicion of endogenous endophthalmitis in the right eye. The baby was diagnosed with acute synovitis of the right knee and was on treatment. On examination, the right eye showed a focal lens abscess with pars plana granuloma, with a temporal retinal fold and persistent fetal vasculature stalk arising from the disc. The left eye showed floating posterior vitreous exudates. The right eye underwent pars plana lensectomy and vitrectomy. A cryotherapy was performed for the granuloma, and an intravitreal antifungal was injected. The left eye underwent lens-sparing vitrectomy with intravitreal antifungal. Both eyes' vitreous biopsy samples confirmed Candida by fungal polymerase chain reaction (PCR). The pediatrician continued systemic antifungal. Both eyes showed resolved endogenous endophthalmitis with favorable outcomes at 1-month post-surgery.

Conclusion: Early aggressive surgical intervention with lensectomy for lens abscess, complete vitrectomy with base shaving, Cryotherapy for fungal granuloma, and intravitreal and systemic antifungal agents for endogenous endophthalmitis plays a pivotal role in targeting localized fungal lesions to control their progression.