Abstract
Purpose: To characterize the clinical features, treatment modalities, and visual outcomes of culture-proven exogenous Fusarium endophthalmitis managed at a tertiary referral center.
Methods: This retrospective, single-center, consecutive case series included 14 eyes of 14 patients with culture-proven exogenous Fusarium endophthalmitis treated between October 2014 and December 2025. Diagnosis was confirmed by positive intraocular (aqueous or vitreous) cultures. Clinical records were reviewed for demographics, presenting characteristics, treatment course, complications, and visual and intraocular pressure outcomes.
Results: Median presenting best-corrected visual acuity (BCVA) was 2.40 logMAR (∼20/5000). Infection sources included trauma (7/14, 50%), anterior segment surgery (5/14, 36%), and contact lens–associated fungal keratitis (2/14, 14%). All eyes required combined antifungal therapy (topical, intravitreal, intracameral, and/or intrastromal with systemic treatment) and surgical intervention, including therapeutic penetrating keratoplasty (14/14, 100%) and vitrectomy (8/14, 57%). Median follow-up was 594 days. Median BCVA at last follow-up remained poor at 2.25 logMAR (∼20/3600), with four of 14 patients (29%) achieving ≥20/400 vision and three of 14 patients (21%) having light perception or no light perception. Complications occurred in 10 of 14 eyes (71%), most commonly ocular hypertension or secondary glaucoma (8/10, 80%) and retinal detachment (3/10, 30%). No eyes required enucleation or evisceration.
Conclusions: Exogenous Fusarium endophthalmitis is a serious ocular infection requiring multimodal therapy and multiple surgical interventions, yet long-term visual outcomes remain poor. Early fungal recognition and prompt antifungal treatment may improve outcome.