Cryptococcal chorioretinitis and endophthalmitis.

The diagnosis of endogenous ophthalmic fungal infection may be difficult. A patient initially presented with hydrocephalus and later developed a progressive bilateral intraocular inflammation unresponsive to corticosteroids or antituberculous therapy. Further evaluation with vitreous biopsy study and lumbar puncture led to the diagnosis of cryptococcal chorioretinitis, endophthalmitis, and meningitis. Initial treatment with intravenous amphotericin failed to control the intraocular infections. Vitrectomy and intravitreal injections of amphotericin combined with the systemic intravenous amphotericin halted progression of the intraocular disease. This case demonstrates the difficulty in making the diagnosis of an endogenous fungal endophthalmitis and the value of diagnostic vitreous biopsy study in cases of increasing intraocular inflammation unresponsive to medical therapy. It also suggests the usefulness of vitrectomy combined with intravitreal amphotericin in cases of fungal endophthalmitis that are unresponsive to systemic antifungal agents.