Bilateral Aspergillus Endophthalmitis Following Cataract Surgery: A Diagnostic and Therapeutic Challenge; Case Report

Abstract

Abstract Purpose: To describe a case of bilateral Aspergillus endophthalmitis occurring four months after bilateral cataract surgery manifesting as a spectacular filamentary branching on the IOL/capsular surface Case presentation: A 66-year-old male known case of CLL, which had previously undergone bilateral cataract surgery in the same session, presented with bilateral decreased vision and vitreous haziness. Vitreous sampling showed aspergillus growth along with negative cytopathology and unremarkable systemic evaluation. Despite 23G deep-vitrectomy and initiation of systemic and intravitreal Voriconazole, a spectacular figure of filamentary branching growth on the IOL/capsular surface appeared in both eyes sequentially, which necessitated bilateral en bloc capsulectomy and IOL removal. Following further recurrence, the patient underwent re-deep vitrectomy, cryotherapy, and medication change to Amphotericin B, which led to a stable ophthalmic state up to this point. Conclusion: Along with challenging diagnosis in chronic post-op fungal endophthalmitis, anti-fungal resistance, the patient’s immunosuppression, and delayed IOL/capsular removal may lead to a worse prognosis.