Culture-proven fungal endophthalmitis following phakic ICL implantation: Case report and review of literature

Endophthalmitis after implantable collamer lens (ICL) implantation is a rare but dreaded complication. This report highlights the challenges in the aetiological diagnosis and management of post-ICL fungal endophthalmitis along with a review of literature. A 32-year-old male was referred for management of right eye (OD) post-ICL endophthalmitis. OD BCVA was 6/18 with hypopyon, clear lens (ICL explanted) with clear vitreous. Though the first aqueous tap did not reveal any bacteria or fungi, the repeat aqueous tap revealed the presence of fungi. The patient was managed with intravitreal voriconazole injections but worsened clinically. The patient underwent lensectomy, vitrectomy, and intravitreal voriconazole. The fungus isolated from the vitreous aspirate was identified as Aspergillus flavus . Postoperatively, intracameral, topical, and oral antifungals were continued. At the 1-month follow-up, OD BCVA was 6/24 with a clear vitreous cavity and attached retina. To the best of our knowledge, this is the first reported case of culture-proven fungal endophthalmitis, post-ICL implantation in India, and the second reported case in Asia.