Visual and anatomical outcome following submacular surgery for choroidal neovascularization secondary to Candida endophthalmitis

Purpose: To report the long-term visual and anatomical outcomes for patients treated with submacular surgery for choroidal neovascularization associated with endogenous candidal endophthalmitis. Methods: Review of the medical records, fluorescein angiograms, fundus photographs, and histopathologic specimens of patients treated with submacular surgery for choroidal neovascularization following candidal endophthalmitis. Results: This series included 3 patients (1 woman and 2 men) who were 26, 30, and 60 years of age. Each patient had received systemic antifungal treatment for culture-proven candidal septicemia before the development of choroidal neovascularization. Each patient had bilateral choroidal neovascularization diagnosed by biomicroscopic examination and angiographic appearance: 2 eyes had an active subfoveal membrane; 2, an active juxtafoveal subretinal membrane; and 2, a mixture of active subfoveal neovascularization with subfoveal fibrosis. Submacular surgery was performed on five eyes with choroidal neovascularization; one eye with subfoveal fibrosis was observed. Visual acuity improved substantially in 4 eyes of 3 patients treated with submacular surgery. Visual improvement was limited in the two eyes with preexisting submacular fibrosis. During 13-month to 82-month follow-ups, vision remained stable, with no recurrence of neovascularization. Conclusion: Choroidal neovascularization can cause severe visual loss in patients with endogenous candidal infection. Submacular surgery with removal of choroidal neovascularization may restore vision in selected patients. Subfoveal fibrosis may limit visual improvement.