Revisiting the Utility of Inpatient Screening for Ocular Candidiasis: An Eight-Year Retrospective Study.

Abstract

Purpose: We sought to re-evaluate the utility of inpatient ocular Candidiasis screening, subsequent interventions, and outcomes, to ultimately guide alignment between American Academy of Ophthalmology (AAO) and Infectious Diseases Society of America (IDSA) guidelines.

Methods: A retrospective cohort study was conducted from 2017-2024 at two tertiary care centers in the New York metropolitan area. Inclusion criteria included positive Candidal cultures, a pertinent International Classification of Diseases, 10^th revision (ICD-10) code, or both. Culture results, mental status, visual acuity, ocular symptoms, systemic antifungal use, dilated fundus exam (DFE) findings, immunocompromised status, and interventions performed were recorded.

Results: Of 897 patient encounters meeting inclusion criteria, 285 (31.8%) underwent consultation to rule-out ocular Candidiasis. Among these patients, 212 (74.4%) had an unremarkable DFE, 35 (12.3%) had DFE findings attributable to other comorbidities, 24 (8.4%) had nonspecific DFE findings requiring follow-up, nine (3.2%) were diagnosed with Candida retinitis, and one (0.4%) had Candida endophthalmitis. There were no statistically significant differences in the odds of DFE positivity between the immunocompromised versus immunocompetent group (χ2 = 0.881, p = 0.348) or the symptomatic versus asymptomatic group (χ2 = 0.297, p = 0.586). During the entire study period, no ophthalmology-directed interventions were made.

Conclusion: Candida endophthalmitis and Candida retinitis are rare in the inpatient setting, even in patients with confirmed Candidemia. Patients are universally started on empiric intravenous antifungal treatment by primary or infectious disease teams prior to ophthalmology consultation, limiting the yield of these examinations. Further studies should be undertaken to create a protocol for these patients such that serious sequelae of disease are prevented while resources are also utilized appropriately.