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2026 OMIG Abstract

Aspergillus Endophthalmitis: Clinical Features, Management, and Visual Outcomes

Sujin Kang, Harry W. Flynn, Jr., William E. Smiddy, Alexander J. Alfonso, Sotiria Palioura,
Guillermo Amescua, and Sonia H. Yoo

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida

Purpose: To characterize the microbiologic findings, clinical features, management, and outcomes of exogenous and endogenous Aspergillus endophthalmitis.

Methods: This retrospective consecutive case series included patients with Aspergillus endophthalmitis treated at Bascom Palmer Eye Institute from October 2014 through December 2025. Demographic characteristics, infection source, microbiologic results, presenting findings, treatment modalities, complications, and best-corrected visual acuity (BCVA) outcomes were reviewed.

Results: Fourteen eyes of 14 patients were included. Median age was 62 years, and 10 patients (71%) were male. Nine infections (64%) were exogenous, most commonly associated with keratitis, surgery, or trauma, and five (36%) were endogenous. Intraocular infection was culture-confirmed in 12 eyes (86%); identified organisms included A. fumigatus, A. flavus, and A. niger. Median presenting BCVA was 2.40 logMAR, and vitritis was present in all eyes. Endogenous cases occurred exclusively in patients with systemic disease or immunocompromising conditions and demonstrated less frequent hypopyon and more variable presenting vision than exogenous cases. All eyes received intravitreal antimicrobial therapy, including voriconazole in 10 (71%) and amphotericin B in four (29%). Systemic antifungal therapy was administered in 11 patients (79%). Pars plana vitrectomy was performed in 12 eyes (86%), including repeat vitrectomy in four. At a median follow-up of 554 days, median final BCVA was 2.70 logMAR. Seven eyes (50%) had light-perception or no-light-perception vision, three (21%) developed phthisis, and one (7%) achieved 20/200 or better. No eye underwent enucleation or evisceration.

Conclusions: Aspergillus endophthalmitis caused severe visual morbidity despite multimodal management. Exogenous and endogenous infections demonstrated distinct clinical patterns. Early recognition, prompt microbiologic diagnosis, intravitreal antifungal therapy, and individualized surgical intervention are essential, although visual prognosis remains guarded.