Endogenous endophthalmitis with iridolenticular involvement – a case report and systematic review Review article

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Ru Jian Jonathan Teoh
Yin Peng Lai
Rohanah Alias
Ahmad Tarmidzi Nor Azita
Swee Ying Choo


Endogenous endophthalmitis (EE) is a sight- and life-threatening disease. EE associated with the involvement of iris and crystalline lens is an uncommon presentation. We reported a case of EE with iridolenticular involvement in a 19-year-old woman with a history of candidemia. Therapeutic vitrectomy with lensectomy was performed, and the patient was treated with intravitreal meropenem and amphotericin B. She was discharged with 6 weeks of oral fluconazole. At follow-up, her vision was 20/60 with aphakic correction. We also conducted a systematic review of the current literature to analyse the clinical features, risk factors, and outcomes of EE with iridolenticular involvement. The systematic review included 10 cases, and found that Candida albicans was the main causative organism. Intravenous drug use and a history of invasive procedures were important risk factors. 70% of the cases required vitrectomy and lensectomy. Post treatment, majority of the cases (80%) had a good visual prognosis of better than 20/60. Our results suggested that in cases of EE with iridolenticular involvement, early surgical removal of the infectious nidus via vitrectomy and lensectomy is recommended for a good visual outcome. A high level of suspicion is crucial in diagnosing the disease, and early aggressive therapy is fundamental.


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Teoh RJJ, Lai YP, Alias R, Nor Azita AT, Choo SY. Endogenous endophthalmitis with iridolenticular involvement – a case report and systematic review. Ophthatherapy [Internet]. 2023Dec.22 [cited 2024Jun.20];10(4):253-60. Available from: https://journalsmededu.pl/index.php/ophthatherapy/article/view/2824
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1. Sadiq MA, Hassan M, Agarwal A et al. Endogenous endophthalmitis: diagnosis, management, and prognosis. J Ophthal Inflamm Infect. 2015; 5(1): 32.
2. Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010; 4: 121-35.
3. Haseeb AA, Elhusseiny AM, Siddiqui MZ et al. Fungal Endophthalmitis: A Comprehensive Review. JoF. 2021; 7(11): 996.
4. Lim HW, Shin JW, Cho HY et al. Endogenous endophthalmitis in the Korean population: A Six-Year Retrospective Study. Retina. 2014; 34(3): 592-602.
5. Sharma S, Padhi TR, Basu S et al. Endophthalmitis patients seen in a tertiary eye care centre in Odisha: a clinico-microbiological analysis. Indian J Med Res. 2014; 139(1): 91-8.
6. Kaur K, Gurnani B. Lens Abscess. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Online.
7. Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71.
8. Lingappan A, Wykoff CC, Albini TA et al. Endogenous Fungal Endophthalmitis: Causative Organisms, Management Strategies, and Visual Acuity Outcomes. Am J Ophthalmol. 2012; 153(1): 162-166.e1.
9. Budmann GA, Parisi FB, Ortiz GB et al. Anterior uveal fungal abscess in an HIV positive patient. Arch Soc Esp Oftalmol (Engl Ed). 2021; 96(7): 388-91.
10. Pierce J, Warrier N, Antonopoulos C et al. Iris abscess a rare presentation of intravenous drug abuse associated Candida endophthalmitis. Am J Ophthalmol Case Rep. 2016; 4: 27-9.
11. Cumurcu T, Demirel S, Doganay S. Iris abscess as an unusual presentation of endogenous endophthalmitis after intramuscular injection. Ocul Immunol Inflamm. 2010; 18(3): 190-1.
12. Ramonas KM, Freilich BD. Iris abscess as an unusual presentation of endogenous endophthalmitis in a patient with bacterial endocarditis. Am J Ophthalmol. 2003; 135(2): 228-9.
13. Mali JO, Falk NS, Mali YP et al. Endogenous endophthalmitis with iris abscess after routine dental cleaning. JAMA Ophthalmol. 2015; 133(5): 616-7.
14. Braich PS, Chang JS, Albini TA et al. Irido-lenticular abscess as the initial sign of Candida albicans endogenous endophthalmitis. Ophthalmic Surg Lasers Imaging. 2011; 42: e107-9.
15. Zeiter JH, Koch DD, Parke DW et al. Endogenous Endophthalmitis With Lenticular Abscess Caused by Enterobacter Agglomerans (Erwinia Species). Ophthalmic Surg Lasers Imaging. 1989; 20(1): 9-9.
16. Monshizadeh R. Isolated Anterior Uveitis as the Initial Sign of Systemic Candidemia. Arch Ophthalmol. 2003; 121(1): 137.
17. Fahey DK, Fenton S, Cahill M et al. Candida endophthalmitis: A diagnostic dilemma. Eye. 1999; 13(4): 596-8.
18. Mir TA, Papudesu C, Fang W et al. Incidence of Drug Use–Related Endogenous Endophthalmitis Hospitalizations in the United States, 2003 to 2016. JAMA Ophthalmol. 2021; 139(1): 18.
19. Patel SN, Rescigno RJ, Zarbin MA et al. Endogenous endophthalmitis associated with intravenous drug abuse. Retina. 2014; 34(7): 1460-5.
20. Ng KWP, Mukhopadhyay A. Streptococcus constellatus bacteremia causing septic shock following tooth extraction: a case report. Cases J. 2009; 2(1): 6493.
21. Taylor TA, Unakal CG. Staphylococcus aureus. In: StatPearls [Internet]. StatPearls Publishing; 2021.
22. Keynan Y, Finkelman Y, Lagacé-Wiens P. The microbiology of endophthalmitis: global trends and a local perspective. Eur J Clin Microbiol Infect Dis. 2012; 31(11): 2879-86.
23. Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2016; 62(4): e1-50.
24. Khan MSA, Ahmad I, Aqil F et al. Virulence and Pathogenicity of Fungal Pathogens with Special Reference to Candida albicans. In: Ahmad I, Owais M, Shahid M et al. (ed). Combating Fungal Infections. [Internet]. Springer, Berlin, Heidelberg 2010: 21-45. Online.
25. Tumbarello M, Posteraro B, Trecarichi EM et al. Biofilm Production by Candida Species and Inadequate Antifungal Therapy as Predictors of Mortality for Patients with Candidemia. J Clin Microbiol. 2007; 45(6): 1843-50.
26. Binder MI, Chua J, Kaiser PK et al. Endogenous Endophthalmitis: An 18-Year Review of Culture-Positive Cases at a Tertiary Care Center. Medicine. 2003; 82(2): 97-105.
27. Kullberg BJ, Arendrup MC. Invasive Candidiasis. N Engl J Med. 2015; 373(15): 1445-56.
28. Durand ML. Bacterial and Fungal Endophthalmitis. Clin Microbiol Rev. 2017; 30(3): 597-613.
29. Breazzano MP, Day HR, Bloch KC et al. Utility of Ophthalmologic Screening for Patients With Candida Bloodstream Infections: A Systematic Review. JAMA Ophthalmol. 2019; 137(6): 698.