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Retinal Physician

Article

Treatment Strategies in Endogenous Fungal Endophthalmitis

Uveitis Corner: Data from a recent multicenter study reveal substantial variation in initial therapy selection and regional differences in the management of this condition.

By: Arthi Venkat, MD, MS, Eleanor M. Burton, MD
Retinal Physician January 1, 2026 Vol 23, Issue January 2026 Page(s): 20-21
Objective:

To evaluate treatment strategies and outcomes for endogenous fungal endophthalmitis (EFE) across multiple institutions from 2010 to 2023.

Approach:
    Key Findings:
    • Endogenous endophthalmitis accounts for 5% to 10% of all endophthalmitis cases, with fungal and bacterial organisms each representing about half, highlighting the need for tailored treatment strategies.
    • Candida was the most frequently identified organism, while mold and culture-negative cases each accounted for approximately 20%, indicating diverse etiologies.
    • 72% of eyes received combination systemic and intravitreal antifungals, a significant increase from previous studies, suggesting evolving treatment paradigms.
    • Voriconazole (34%) and fluconazole (30%) were the most frequently used initial systemic agents, reflecting current preferences in antifungal therapy.
    • Regional variations were noted in treatment approaches, with differences in the use of IV systemic therapy and surgical interventions, underscoring the need for region-specific guidelines.
    Interpretation:

    The management of EFE is complex and varies significantly by region, with systemic markers influencing treatment choices more than ocular findings. A multidisciplinary approach is essential for optimizing patient outcomes, as evidenced by the study's findings.

    Limitations:
    • Limited explicit guidelines for managing EFE based on low-quality evidence, which may hinder optimal treatment.
    • No studies have evaluated intraocular penetration of oral or IV fluconazole or voriconazole in inflamed or infected eyes, raising concerns about treatment efficacy.
    Conclusion:

    A comprehensive approach considering ocular involvement is crucial for optimizing treatment outcomes in EFE, despite the lack of definitive evidence favoring one systemic therapy route over another.

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