Overall Prevalence of Candida Endophthalmitis Higher Than Previously Reported

The overall prevalence of concordant Candida endophthalmitis prevalence was higher than that cited by the American Academy of Ophthalmology, suggesting the need to establish optimal screening protocols.

Results of a systematic review and meta-analysis published in Clinical Infectious Disease indicate that the overall prevalence of concordant Candida endophthalmitis (CE) is higher compared with the prevalence reported by the American Academy of Ophthalmology. 

Researchers conducted a systematic review and meta-analysis to assess the prevalence of ocular candidiasis (OC) and CE in patients with candidemia. A total of 1597 studies were identified, of which 70 were included in the systematic review and 35 were included in the meta-analysis. There were 8599 patients with candidemia who underwent ophthalmologic screening in this analysis. The pooled prevalence of OC and CE was calculated using a generalized linear mixed model. 

Overall, the pooled prevalence rates of patients screened for OC, overall CE, concordant CE, and discordant CE were 10.7% (95% CI, 8.4%-13.5%), 3.1% (95% CI, 2.1%-4.5%), and 1.8% (95% CI, 1.3-2.6%), and 7.4% (95% CI, 4.5%-12%), respectively.

A significantly higher concordant CE prevalence of patients screened was noted among studies conducted in Asia (3.6%; 95% CI, 2.9%-4.6%) compared with those conducted in both Europe 1.4% (1.4%; 95% CI, 0.4%-5%) and America (1.4%; 95% CI, 0.9%-2.2%; P <.01).

There is an urgent need for more nuanced, evidence-based screening protocols to detect Candida ocular involvement.

The researchers hypothesized that this higher concordant CE prevalence may be due to a component of genetic predisposition favoring more invasive fungal infections. In addition, the significant difference in the prevalence of ocular complications may explained by high heterogeneity between the studies and different definitions used for OC and CE. 

Further analysis showed that CE occurrence was significantly associated with a diagnosis of Candida albicans candidemia infection (pooled odds ratio [pOR], 3.02; 95% CI, 1.67-5.46; P <.01), as well as the presence of total parenteral nutrition (pOR, 6.9; 95% CI, 3.6-13.4, I2 =0%; P <.01).

Several limitations were noted, including the study design, the lack of data on candidemia duration prior to hospitalization, and the potential overestimation of the true prevalence ofocular Candida complications. 

According to the researchers, “There is an urgent need for more nuanced, evidence-based screening protocols to detect Candida ocular involvement.”

Disclosures: Multiple authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.


Phongkhun K, Pothikamjorn T, Srisurapanot K, et al. Prevalence of ocular candidiasis and Candida endophthalmitis in patients with candidemia: a systematic review and meta-analysis. Clin Infect Dis. Published online February 8, 2023. doi:10.1093/cid/ciad064