Aspergillus Endophthalmitis: Clinical Features, Treatment Modalities, and Visual Outcomes

Purpose: The purpose of this study was to evaluate clinical features, treatment modalities, and visual outcomes of Aspergillus endophthalmitis in a tertiary referral center. Methods: This was a retrospective consecutive case series of patients with Aspergillus endophthalmitis treated at Bascom Palmer Eye Institute from October 2014 to December 2025. Demographics, infection source, microbiologic findings, presenting features, treatments, 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 men. Nine eyes (64%) had exogenous disease and five (36%) had endogenous disease. Aspergillus infection was culture-proven in 12 eyes (86%) and presumed clinically in 2 (14%); identified species included A. fumigatus, A. flavus, and A. niger. Median presenting BCVA was 2.40 logMAR (approximately hand motion), and vitritis was present in all eyes. All eyes received intravitreal therapy, most commonly voriconazole (71%); systemic antifungal therapy was administered in 79%. Pars plana vitrectomy (PPV) was performed in 12 eyes (86%), including repeat PPV in 4. Median follow-up was 554 days. Final median BCVA was 2.70 logMAR (approximately light perception). Only 1 eye (7%) achieved 20/200 or better, whereas 7 eyes (50%) had final light perception or no light perception vision. Phthisis developed in three eyes (21%), and no eyes underwent evisceration or enucleation. Conclusions: Aspergillus endophthalmitis was associated with poor visual outcomes despite multimodal therapy. Exogenous and endogenous cases showed distinct clinical patterns, supporting early microbiologic diagnosis, timely antifungal therapy, and individualized surgical intervention.