Utility of Intraocular Fluid β-D-glucan Testing in Fungal Endophthalmitis: A Series of 5 Cases

Case series Patients: Female, 68-year-old • Female, 60-year-old • Male, 36-year-old • Male, 49-year-old • Male, 3-year-old Final Diagnosis: Fungal endophthalmitis Symptoms: Blurred vision • fatty keratic precipitates • floater cells • hypopyon Medication: — Clinical Procedure: An intravitreal injection of 10 μg of amphotericin B Specialty: Infectious Diseases OBJECTIVE: Challenging differential diagnosis BACKGROUND: In clinical practice, the presentation of fungal endophthalmitis is often occult and confusing, so it is difficult to make an early diagnosis. The aim of this study was to evaluate the utility of β-d-glucan (BDG) testing in diagnosis, management, and prognosis of fungal endophthalmitis. CASE REPORTS: We present a retrospective, observational case series of 5 fungal endophthalmitis cases, 3 of which were endogenous and 2 exogenous. There were significantly elevated BDG levels in all cases, which was consistent with the pathological diagnosis. Four cases were diagnosed as fungal endophthalmitis through smear or culture and gene chip analysis of intraocular fluid. CONCLUSIONS: Fungal endophthalmitis is rare, and its diagnosis is difficult because of its occult nature. Therefore, BDG testing may be required as an auxiliary examination for the early diagnosis of fungal endophthalmitis. Compared to cultures and smears, intraocular fluid BDG testing has a higher sensitivity for detecting fungal endophthalmitis.