Purpose: Scedosporium apiospermum is a rare cause of chronic endophthalmitis following routine cataract surgery. Methods: We present a case report and literature review of Scedosporium apiospermum endophthalmitis and related infections. Results: A 59-year-old Trinidadian woman with chronic endophthalmitis following cataract surgery presented for evaluation in the United States. Prior to presentation, she had been treated with intravitreal (IVT) vancomycin and had undergone 2 pars plana vitrectomies (PPVs). Examination revealed hand motion vision, significant anterior chamber inflammation with a hypopyon, and posterior chamber inflammation without retained lens fragments. After failing treatment with topical steroids and IVT antibiotics, she underwent repeat PPV, vitreous biopsy, anterior chamber washout, and intraocular lens removal with the capsular bag. Intraocular cultures were positive for Scedosporium apiospermum sensitive to voriconazole. The patient was successfully treated with oral voriconazole. Conclusions: Fungal endophthalmitis should be considered in patients with chronic endophthalmitis refractory to IVT antibiotics.

Masquerade syndromes encompass a heterogeneous group of ocular conditions that mimic intraocular inflammation but are caused by non-inflammatory processes. Accurate distinction from true uveitis is critical, as misdiagnosis can lead to inappropriate immunosuppression, delayed definitive therapy, and irreversible visual loss. This review focuses on non-neoplastic disorders presenting as posterior segment inflammation, highlighting their epidemiology, clinical hallmarks, multimodal imaging features, and diagnostic pitfalls. We discuss inherited retinal degenerations such as retinitis pigmentosa, chronic endophthalmitis, retinal detachment syndromes, intraocular foreign bodies, idiopathic uveal effusion, central serous chorioretinopathy, amyloidosis, and vascular anomalies including Coats disease. Developmental anomalies like persistent fetal vasculature and rare entities such as X-linked retinoschisis are also examined. For each disorder, we outline distinguishing characteristics from uveitis and propose a systematic diagnostic approach integrating history, examination, targeted laboratory testing, and imaging modalities including OCT, FAF, FA, ICGA, and ultrasonography. Early recognition of these mimickers is essential to guide appropriate management, prevent unnecessary exposure to corticosteroids or immunomodulators, and optimize visual prognosis.

To assess the preferred practice patterns of endophthalmitis management and prophylaxis among the members of Vitreo Retina Society of India (VRSI). An online questionnaire was circulated among the VRSI members, enquiring details on clinical presentation of endophthalmitis, initial management protocols of acute and chronic endophthalmitis, usage of antibiotics, steroids, and silicone oil (SO) in endophthalmitis, and prophylaxis followed for prevention of endophthalmitis. A total of 313 (20.2%) responses were obtained. The mean age of the respondents was 43.2 ± 0.5 years, and there was a male predominance (n = 231, 73.8%). Post-cataract surgery endophthalmitis (PCSE) was the most common (n = 273, 87.2%) reported variant, followed by post-traumatic endophthalmitis (PTE) (n=37,11.8%). Over 50% (n = 181, 57.8%) of respondents followed Endophthalmitis Vitrectomy Study (EVS) guidelines for acute PCSE and about 60% (n = 194, 61.9%) would not extrapolate EVS guidelines to other forms of endophthalmitis. A total of 159 (50.8%) respondents preferred using a vitreous/anterior chamber tap with needle, and vitreous biopsy with vitrector was preferred by 117 (37.3%) respondents. Vancomycin-ceftazidime remains the preferred combination of empirical intravitreal antibiotics (IVAs), and 169 (54%) preferred injecting intravitreal steroids along with IVA. About one-fourth (n = 90, 28.8%) of the respondents preferred pars plana vitrectomy as the initial management for PCSE. SO was used mostly in cases with PTE (n = 176, 56.2%). Prophylactic measures to prevent endophthalmitis varied among the respondents. Majority of the Indian vitreoretinal surgeons felt the need for amendment in the EVS guidelines, but would prefer to follow the EVS guidelines for managing endophthalmitis at present.

We present the diagnosis and treatment strategy in a 76-year-old woman with chronic postoperative endophthalmitis caused by Cutibacterium acnes (C. acnes). She presented with persistent blurred vision of her right eye for 9 months after cataract surgery at a local clinic and was referred to our hospital. On examination, the right eye's best-corrected visual acuity (BCVA) was 0.03, and the intraocular pressure (IOP) was 35 mmHg. Slit-lamp examination revealed congested conjunctiva, cells 1+ and flares 1+ in the anterior chamber, white plaque on the intraocular lens and capsule, and vitreous opacity. The B-scan also revealed vitreous opacity. Initial treatment of vitrectomy, partial capsulectomy (PC) with intraocular antibiotics (IOABs) (vancomycin and ceftazidime) injection was done immediately after the IOP was controlled to a normal range (18 mmHg). The IOP on postoperative day 1 was 15.3 mmHg. Although vitreous cultures yielded no bacterial growth, the polymerase chain reaction (PCR) confirmed the diagnosis of C. acnes infection. PCR has several advantages over traditional culture methods, providing high sensitivity, specificity, and speed. Postoperative examination revealed no cells in the anterior chamber, less plaque, and a clear vitreous cavity. The BCVA improved to 0.7 at 6 months after the surgery. No guidelines or standard treatments exist due to the broad range of the severity of postoperative chronic endophthalmitis. We suggest a combination of pars plana vitrectomy, PC, and IOAB injection as the initial treatment for chronic postoperative C. acnes endophthalmitis.

This report details an uncommon occurrence of chronic endophthalmitis following cataract surgery attributed to an infection by Trichosporon inkin (T. inkin). The infection was identified through MALDI-TOF mass spectrometry along with sequencing analysis. Although the patient exhibited a robust immune response, the infection escalated quickly from the right eye to the left. Treatment involved vitrectomy and peeling surgery on the right eye, paired with systemic fluconazole antifungal therapy and intravitreal injection, resulting in significant recovery. The visual acuity of the right eye enhanced from finger counting to 20/63. This account represents the inaugural documented instance of endophthalmitis caused by T. inkin that was effectively managed with fluconazole. This underscores the critical role of vitreous humor enrichment culture and antifungal susceptibility testing of T. inkin in the treatment of endophthalmitis.