Twelve-month functional and structural outcomes of Candida endogenous endophthalmitis in immunocompetent patients: a longitudinal cohort study of an outbreak.

BACKGROUND

To characterize twelve-month visual outcomes, structural complications, and retinal pigment epithelium (RPE) dynamics stratified by initial lesion morphology in an iatrogenic, single-center outbreak of Candida endogenous endophthalmitis (EFE) among immunocompetent patients.

METHODS

This retrospective longitudinal cohort study included patients from a single-source outbreak. Of 26 eyes in the original cohort, 18 were classified with chorioretinal involvement and 8 with intraretinal or preretinal involvement. After excluding eyes with severe baseline destruction or loss to follow-up, 13 chorioretinal eyes and 8 intraretinal or preretinal eyes completed the twelve-month follow-up. Main outcome measures included best-corrected visual acuity (BCVA), complication rates, the incidence of secondary macular neovascularization (MNV) using optical coherence tomography angiography (OCTA), and longitudinal RPE lesion area changes quantified via optical coherence tomography (OCT).

RESULTS

Although both groups experienced functional improvement after treatment, the chorioretinal group had significantly worse final BCVA at twelve months (median 0.80 versus 0.20 LogMAR; P = 0.005) and a higher overall complication burden (92.3% versus 25.0%; P < 0.001) than the intraretinal or preretinal group. Secondary MNV developed in 100.0% of evaluable eyes in the chorioretinal group (10/10; 95% CI, 69.2%-100.0%), whereas no MNV occurred in the intraretinal/preretinal group (0/8; 95% CI, 0.0%-36.9%; P < 0.001). In the chorioretinal group, the RPE lesion area increased during the first three months and subsequently decreased by month twelve, occurring concurrently with sustained BCVA improvement.

CONCLUSIONS

Initial chorioretinal involvement was associated with poorer visual recovery and a markedly higher incidence of secondary MNV. The early expansion of RPE lesions alongside visual improvement likely reflects tissue remodeling and may be less suggestive of ongoing infection. These findings support routine OCT and OCTA surveillance and timely anti-vascular endothelial growth factor therapy for eyes with chorioretinal involvement.