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Endogenous fungal endophthalmitis: international, multicentre, retrospective analysis of clinical outcomes following surgical and medical management, and screening

Eye volume 39, pages 3249–3256 (2025)Cite this article

Subjects

This article has been updated

Abstract

Objectives

To report the clinical outcomes of surgical management versus medical management alone in cases of endogenous fungal endophthalmitis. Additionally, we explore the role of routine ophthalmic screening.

Methods

Retrospective observational multicentre study. We examined the databases of five UK centres and a tertiary centre in the United States for patients with Candida septicaemia (candidemia) and/or clinically established endogenous fungal endophthalmitis. Clinical data including visual acuity and other outcomes were reviewed and analysed with statistics.

Results

A total of 404 patients were included from all centres. Forty-six eyes were diagnosed clinically as presumed EFE - of which 25 were later confirmed with positive vitreous biopsies. 18/46 received systemic medical treatment with or without intravitreal injection of antifungal agents and without a significant logMAR vision improvement from 1.15 ± 0.29 at baseline to 0.74 ± 0.21 at last follow up. The remaining 28/46 eyes received both systemic medical treatment and vitrectomy, and visual acuity improved from 1.56 ± 0.19 to 1.14 ± 0.21 after surgery (p = 0.04). At the last follow up, 18/28 eyes (64.3%) had an attached retina with no tamponade, three attached under oil and two ending up with detached retina. Silicone oil was retained in three eyes due to either patient comorbidities precluding further surgery or due to surgeon preference to ensure long-term anatomical stability. Two cases resulted in macular and/or fibrovascular scarring and one in enucleation. Out of 359 patients with candidemia, 95 (26.4%) had ophthalmological examination and only 9 (9.47% of those examined and 2.5% of the total) had endogenous fungal endophthalmitis (7 confirmed with vitreous sample cultures and 2 presumed).

Conclusion

Although our findings suggest that vitrectomy may improve outcomes in select cases of EFE, the retrospective nature of our study and the potential for bias mandate cautious interpretation. Therefore, further prospective studies are necessary to shed more light with novel insights. A more targeted, case-by-case screening paradigm for patients with candidemia is advocated for optimum outcomes and efficient use of resources.

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Data availability

The raw data (excel sheet) that support the findings of this study are available upon request from the corresponding author (A.W.).

Change history

  • 12 November 2025

    In this article the acknowledgement section has been modified. The following sentence is added: The authors gratefully acknowledge Dr. Kashika Singh, BMBS, BMedSci (Hons), and Dr. Haytham Rezq, who were affiliated with University Hospital Southampton NHS Foundation Trust at the time of data collection, for their valuable contribution to the acquisition of data supporting this work. Dr. Singh is currently affiliated with Worcestershire Acute Hospitals Trust, and Dr. Rezq is currently affiliated with Magrabi Health Hospitals and Centres.

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Acknowledgements

The authors gratefully acknowledge Dr. Kashika Singh, BMBS, BMedSci (Hons), and Dr. Haytham Rezq, who were affiliated with University Hospital Southampton NHS Foundation Trust at the time of data collection, for their valuable contribution to the acquisition of data supporting this work. Dr. Singh is currently affiliated with Worcestershire Acute Hospitals Trust, and Dr. Rezq is currently affiliated with Magrabi Health Hospitals and Centres.

Author information

Authors and Affiliations

  1. Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom

    Amr Wassef, Dimitrios Kalogeropoulos & Bhaskar Gupta

  2. Department of Ophthalmology, Kasr Al Ainy Hospitals, Cairo University, Cairo, Egypt

    Amr Wassef

  3. Department of Ophthalmology and Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY, USA

    Mark P. Breazzano, Neha Gupta & Jacqueline Hogan

  4. Flaum Eye Institute, Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA

    Mark P. Breazzano

  5. Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    Kordo Saeed

  6. Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK

    Kordo Saeed

  7. Sunderland Eye Infirmary and Bioscience Inst, Sunderland, UK

    David H. Steel

  8. Bioscience Institute, Newcastle University, Newcastle Upon Tyne, UK

    David H. Steel

  9. Mid & South Essex NHS Foundation Trust (Southend University Hospital) Prittlewell Chase Essex SS00RY, Southend-on-Sea, United Kingdom

    Aman Chandra

  10. Vision & Eye Research Unit, Anglia Ruskin University, Cambridge, UK

    Aman Chandra

  11. Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Roxane J. Hillier, Krishnamoorthy Narayanan, Isabella Mueller & Manjusha Narayanan

  12. Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

    Roxane J. Hillier

  13. Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Tom Williamson & Neruban Kumaran

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Contributions

AW: Organising data, data analysis and statistics, writing the manuscript. DK: Writing the manuscript. BG: Study idea and design. Communication with other centres. Supervising the whole process. Review. MB, KS, DS, AC, RH: Review and revision of manuscript. Southampton data collection team: BG, KS. Newcastle data collection team: RH, KN, IM, MN. St. Thomas’ data collection team: TW, NK. Sunderland data collection team: DS. SUNY, New York data collection team: MB, NG, JH.

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Correspondence to Amr Wassef.

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Wassef, A., Breazzano, M.P., Saeed, K. et al. Endogenous fungal endophthalmitis: international, multicentre, retrospective analysis of clinical outcomes following surgical and medical management, and screening. Eye 39, 3249–3256 (2025). https://doi.org/10.1038/s41433-025-04061-0

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