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PPV and voriconazole for endogenous fungal endophthalmitis outbreak improves visual acuityContaminated IVs Cause Sudden Blindness in Healthy Adults

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Key Takeaway
Consider PPV plus voriconazole for endogenous fungal endophthalmitis in outbreak settings, recognizing limited evidence from a retrospective series.

A retrospective case series from the Ophthalmology Department of Ningde Municipal Hospital evaluated 26 eyes of 17 immunocompetent individuals with endogenous fungal endophthalmitis linked to a history of intravenous infusions at a rural clinic. Patients underwent pars plana vitrectomy (PPV) and intravitreal voriconazole injection, followed by systemic voriconazole therapy.

The primary outcome, best corrected visual acuity (BCVA), improved significantly. Mean BCVA improved from 20/100 to 20/50 (p = 0.00011) after three months of follow-up. Vitreous cultures were positive in 19 out of 26 eyes, showing growth of Candida albicans. Clonal outbreak confirmation was supported by SNP-based phylogenetic analysis, which showed that all sequenced isolates clustered tightly; this included 7 culture-positive Candida albicans vitreous isolates.

Safety and tolerability were not reported. Key limitations include the retrospective case series design, no comparator group, small sample size, and single-center setting. The outbreak was presumed to be caused by intravenous infusion contamination, but causation is not proven. Practice relevance is limited to this specific outbreak setting; however, primary PPV followed by systemic and intravitreal antifungal therapy and an epidemiological investigation could be effective in finding the infectious source and achieving favorable visual outcomes.

Imagine getting a simple IV for hydration. Now imagine that same treatment stealing your sight. This is the scary reality for a group of healthy people. They received fluids that were not clean.

This does not mean every IV infusion is dangerous.

Most eye infections happen to people with weak immune systems. Doctors usually expect this in patients who are already very sick. But this outbreak happened to people who were otherwise healthy.

Healthy Adults Lost Sight After Infusions

The infection started inside the eye itself. It is called endogenous fungal endophthalmitis. Fungi are tiny organisms that can grow in dark, warm places. They traveled through the blood to the eye.

This condition is rare in healthy people. Usually, the body fights off these invaders easily. But contaminated fluids gave the fungi a direct path. The infection grew quickly and caused severe pain.

Patients noticed their vision blurring within days. Some could not see light at all. They rushed to the hospital for help. Doctors were shocked by the severity.

Why Steroids Made Vision Loss Worse

Some patients went to other hospitals first. They were told they had a different eye problem. They received steroid injections to reduce swelling.

Steroids calm the immune system. This is good for inflammation. But it is bad for active infections. The steroids allowed the fungus to grow faster.

Two patients lost all vision permanently. They had been treated with the wrong medicine. This mistake highlights the danger of guessing.

Surgery Saved Eyes in Most Cases

Doctors at the main hospital took action. They performed a procedure called vitrectomy. This surgery removes the fluid inside the eye. It clears out the infection directly.

They also injected medicine into the eye. This medicine kills the fungus on contact. Patients took strong pills to fight the infection from the inside.

Most patients saw their vision return. The average score went from 20/100 to 20/50. This means they could read signs again. Recovery took about three months.

What Happens After the Clinic Closes

The source of the problem was a rural clinic. It was located in a specific region. The clinic provided the contaminated fluids.

Once the clinic closed, the outbreak stopped. No new cases appeared after that date. This suggests the problem was contained.

Doctors found the specific type of fungus. It was Candida albicans. It was the same strain in every patient. This proved they all came from one source.

The study looked at 17 patients. They had 26 eyes affected in total. All of them were immunocompetent. This means their immune systems worked normally.

The study was small and local. It focused on one hospital group. We do not know if this happens everywhere. More research is needed to be sure.

What Happens Next

Doctors are watching for similar cases. They want to catch infections early. They are also checking IV safety standards.

Patients should report vision changes immediately. Do not wait for symptoms to go away. Early treatment saves sight in these cases.

The medical community is learning from this. They are updating how they handle eye pain. They are also testing IV fluids more often.

This event serves as a warning. It shows that even healthy people are at risk. It also shows that treatment works if found fast.

We need to stay alert for new risks. Safety checks in clinics are vital. They protect patients from hidden dangers.

The road ahead involves more testing. Scientists will study the fungus further. They want to prevent future outbreaks.

For now, the clinic is closed. The patients are recovering. The medical team is relieved.

But the lesson remains clear. Always ask about safety before treatment. Your vision is worth the extra check.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
BackgroundAn outbreak of endogenous fungal endophthalmitis (EFE) caused by contaminated intravenous infusion was identified in immunocompetent individuals. We aimed to describe its clinical characteristics and outcomes.MethodsThis retrospective case series included all patients referred with EFE and had a history of intravenous infusions at the same rural clinic, between May 1st, 2024 and November 30th, 2024, to Ophthalmology Department of Ningde Municipal Hospital. Demographic and clinical data were collected. Whole-genome sequencing (WGS) and SNP-based phylogenetic analysis were performed on 7 culture-positive Candida albicans vitreous isolates.ResultsThe inclusion criteria were met in 26 eyes of 17 patients. All were healthy and immunocompetent. On average, patients presented after 24.3 days of symptoms. Presenting best corrected visual acuity (BCVA) ranged from 20/25 to no light perception (NLP). All patients were initially treated with pars plana vitrectomy (PPV) and intravitreal voriconazole injection followed by systemic voriconazole therapy. Vitreous cultures obtained during PPV were positive in 19 eyes, all showing growth of Candida albicans. Three months after treatment, patients’ BCVA improved significantly from a mean of 20/100 to 20/50 (p = 0.00011). All sequenced isolates clustered tightly in SNP-based phylogenetic analysis, supporting a clonal outbreak. Two patients with a final BCVA of NLP were initially misdiagnosed with noninfectious uveitis and treated with an intravitreal steroid injection at other hospitals. Since the closure of the rural clinic, no new cases have been reported.ConclusionsPrimary PPV followed by systemic and intravitreal antifungal therapy and an epidemiological investigation could be effective in finding the infectious source of an EFE outbreak and achieving favorable visual outcomes. Misuse of intravitreal steroids due to incorrect diagnosis could lead to severe vision loss in individuals with EFE.
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