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

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