Endogenous fungal endophthalmitis may present in a debilitated or otherwise healthy host, may be increasing in prevalence, and is most commonly caused by Candida albicans. Recognizing the potential for complications with systemic amphotericin B use, recent investigators have developed several newer principles governing the treatment of such cases. For cases of simple choroiditis or very minimal endophthalmitis (ie, vitritis), systemic treatment with oral fluconazole may be effective; however, if vitritis symptoms persist or progress, vitrectomy allows for better clearing of the organism. Intravitreal amphotericin B in conjunction with vitrectomy has been advocated by many. The most recent series have shown that an extended course of oral fluconazole following vitrectomy without intravitreal amphotericin B affects resolution of infection in the vast majority of patients. Final visual acuity outcomes depend most on the site of initial choroiditis. If the macula is spared and preretinal membranes can be effectively removed, visual acuity results can be exceedingly good.
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