Purpose: To report endogenous fungal endophthalmitis, postrecovery from severe COVID-19 infection in otherwise immunocompetent individuals, treated with prolonged systemic steroids. Methods: Retrospective chart review of cases with confirmed and presumed fungal endogenous endophthalmitis, following severe COVID-19 disease, treated at two tertiary care referral eye institutes in North India. Results: Seven eyes of five cases of endogenous fungal endophthalmitis were studied. All cases had been hospitalized for severe COVID-19 pneumonia and had received systemic steroid therapy for an average duration of 42 ± 25.1 days (range 18–80 days). All the cases initially complained of floaters with blurred vision after an average of 6 days (range 1–14 days) following discharge from hospital. They had all been misdiagnosed as noninfectious uveitis by their primary ophthalmologists. All eyes underwent pars plana vitrectomy (PPV) with intravitreal antifungal therapy. Five of the seven eyes grew fungus as the causative organism (Candida sp. in four eyes, Aspergillus sp. in one eye). Postoperatively, all eyes showed control of the infection with a marked reduction in vitreous exudates and improvement in vision. Conclusion: Floaters and blurred vision developed in patients after they recovered from severe COVID-19 infection. They had received prolonged corticosteroid treatment for COVID-19 as well as for suspected noninfectious uveitis. We diagnosed and treated them for endogenous fungal endophthalmitis. All eyes showed anatomical and functional improvement after PPV with antifungal therapy. It is important for ophthalmologists and physicians to be aware of this as prompt treatment could control the infection and salvage vision.

Microsporidia are obligate intracellular protozoal parasites. They are eukaryotic and spore forming. Increasing interest in this parasite as a pathogen in the ocular tissues in recent times is due to increasing awareness of microsporidia as an ocular pathogen and better methods of identification of the organism. It also can cause intestinal, sinus, pulmonary, muscular and renal diseases, in both immunocompetent and immunosuppressed patients. Ocular microsporidiosis can occur in isolation or as a part of systemic infections. In earlier published literature, ocular involvement in immunocompetent individuals was more in the form of stromal keratitis and immunocompromised individuals were seen to have keratoconjunctivitis. However, later studies show that this pattern has many variations. Occurrence in rainy season with exposure to muddy water and history of minor trauma is now a known factor. Identification by light microscopy from scrapings with KOH, Gram, Giemsa staining is possible. Growth of the organisms, however, is possible only by cell culture. Species identification is done by polymerase chain reaction and by electron microscopy. Immunofluorescent staining techniques are also available in advanced laboratories for species differentiation of microsporidia. Till date, treatment of ocular microsporidia has not been standardized and varies from simple debridement to use of various antibiotics, antiseptics antifungals and antiviral agents.

Purpose:To study the outcome of ocular nocardiosis following intraocular surgery.Materials and Methods:A retrospective review of medical records of all postoperative cases of culture proven Nocardia infection over a period of 3 years, from October 2010 to September 2013, was performed. Microbiological analysis was performed for all cases and included smears and cultures. Fortified 2% amikacin eye drops were the mainstay of treatment. Surgical intervention was performed in case of nonresponse to medical therapy or suspected endophthalmitis.Results:Seven cases of culture proven Nocardia infection were seen. All cases had been operated in a hospital surgical facility. Six followed phacoemulsification, and one followed a secondary intraocular lens implantation. Four patients were part of a cluster infection. The mean duration between the primary surgical procedure and presentation was 16.14 ± 9.82 days. Five patients had infiltrates at the site of the surgical incision. One each had endophthalmitis and panophthalmitis. Six eyes required surgical intervention. Infection was seen to resolve in four eyes. Two eyes went into phthisis, and one was eviscerated. Only two of the six eyes, where in surgical intervention was performed early, obtained a final visual acuity of 20/60.Conclusion:Early surgical intervention, before the involvement of the anterior chamber, may help preserve the anatomic and functional integrity of the eye.