Aspergillus fumigatus endophthalmitis and scleritis
C. Repeat aqueous or vitreous sampling
Patients with postoperative intraocular inflammation require thorough evaluation for infectious causes. Until absence of infection has been established, steroids (choice A) should be used cautiously. Lack of improvement while receiving sufficiently broad antibiotic therapy suggests alternative etiologies rather than inadequate coverage (choice B). When the diagnosis is unclear and vision loss progresses, intraocular fluid testing for atypical organisms, including mycobacteria and fungi, and masquerade syndromes such as lymphoma should be considered (choice C) over continued observation (choice D).
An aqueous sample was sent for broad-range bacterial, mycobacterial, and fungal polymerase chain reaction, which returned positive for Aspergillus fumigatus. The patient started oral voriconazole and high-dose indomethacin treatment and received intravitreal and subconjunctival voriconazole injections. He underwent pars plana vitrectomy with lensectomy and additional intravitreal voriconazole (Figure 2). A dense retrolenticular plaque and multiple vitreous fungal “snowballs” were found intraoperatively; there was no vasculitis or chorioretinitis.