Purpose To evaluate the epidemiologic features, laboratory findings, and treatment of fungal endophthalmitis in north China.

Methods A total of 75 patients (75 eyes) diagnosed with fungal endophthalmitis at the Shandong Eye Institute from January 2000 to December 2010 were included. Patient history, slit-lamp biomicroscopy, etiological agents, direct smear examination, fungal culture, pathogen sensitivity to antifungal drugs, and treatments protocol of the patients were retrospectively evaluated.

Results The patients were 48 males and 27 females, with a mean age of 40.5 years (range, 2 to 85 years). The fungal endophthalmitis was exogenous in 70 eyes (93.3%), among which 45 had keratitis caused by corneal epithelial injury. Three of the other five eyes (7.0%) with endogenous infection had been given high-dose steroids. Hyphae were found in 43 of 61 smear samples (70.5%) by direct microscopic examination. Fungal pathogens cultured from 75 samples were identified as 9 genera and 18 species, among which Fusarium accounted for 65.3% (49) and Aspergillus accounted for 18.7% (14). The minimum inhibitory concentration (MIC) values of amphotericin B and voriconazole that would inhibit the growth of 50% of the tested fungal species (MIC₅₀) and that of 90% of the tested fungal species (MIC₉₀) were lower than those of fluconazole and itraconazole. Thirty-six eyes (48.0%) got improvement after treatment, and global evisceration was preserved in 39 eyes (52.0%).

Conclusions Fungal endophthalmitis in north China is predominantly exogenous. Corneal epithelial injury is the most common etiological factor. Microscopic detection of hyphae and culture from samples are helpful in the diagnosis of this disease. Fusarium ranks first in pathogens, followed by Aspergillus, both more sensitive to amphotericin B and voriconazole than fluconazole and itraconazole. Intravitreal antifungal therapy combined with vitrectomy seems to be effective in the treatment of fungal endophthalmitis.