Microscopic injection of caspofungin targeting a fungal infection in a human eye.

Fighting Fungal Eye Infections: A New Hope with Intravitreal Caspofungin

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"When common antifungals fail, a novel approach offers a beacon of hope for severe eye infections."

Fungal endophthalmitis, a rare but devastating eye infection, typically accounts for 8% to 18% of all culture-positive endophthalmitis cases. Its rarity often translates to a lack of robust, evidence-based treatment strategies, leaving patients with a challenging prognosis.

Traditional treatments sometimes fall short, especially when dealing with resistant strains of fungi. This is where innovative approaches become crucial. The following case report sheds light on a successful intervention using intravitreal caspofungin to combat a particularly stubborn fungal infection.

This article will explore the details of a case involving Stephanoascus ciferrii, an unusual yeast-like fungus, and how it was effectively treated with intravitreal caspofungin. This case offers a promising alternative when conventional antifungal therapies prove ineffective.

The Case: Beating a Resistant Fungal Infection

Microscopic injection of caspofungin targeting a fungal infection in a human eye.

In October 2014, a 57-year-old woman sought help at an eye clinic two weeks after undergoing cataract surgery. Her vision had deteriorated significantly. An examination revealed ciliary injection, numerous cells in the anterior chamber, and a small hypopyon, indicating a severe inflammatory response. Initial treatments with vancomycin were administered, but her condition continued to worsen.

Further investigation, including a pars plana vitrectomy and posterior capsulotomy, led to the identification of Stephanoascus ciferrii. What made this case particularly challenging was the fungus's resistance to commonly used antifungals like fluconazole, voriconazole, and amphotericin B. Traditional treatments were failing, highlighting the urgent need for an alternative approach.

Initial Symptoms: Ciliary injection, anterior chamber inflammation, hypopyon.
Diagnosis: Stephanoascus ciferrii, resistant to common antifungals.
Failed Treatments: Vancomycin, fluconazole, voriconazole, amphotericin B.

Faced with limited options, doctors turned to intravitreal caspofungin, administering multiple injections directly into the vitreous cavity. Initially, 50 µg/0.1 ml of caspofungin was injected, followed by a higher dose of 250 µg/0.1 ml when symptoms recurred. Although the response was gradual, the inflammation eventually subsided, and the patient regained ambulatory vision, which persisted for at least a year.

A Glimmer of Hope

This case marks a significant step forward in the treatment of fungal endophthalmitis. It demonstrates that even when faced with drug-resistant fungi, alternative therapies like intravitreal caspofungin can offer a successful outcome.

The successful treatment of Stephanoascus ciferrii endophthalmitis with intravitreal caspofungin provides clinicians with a valuable option when dealing with similar challenging cases. This approach could be considered for patients with fungal eye infections unresponsive to conventional antifungal therapies.

While further research is needed to fully understand the optimal dosage and long-term effects of intravitreal caspofungin, this case offers a beacon of hope for patients facing severe, drug-resistant fungal eye infections, potentially saving their sight and improving their quality of life.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.5935/0004-2749.20170048, Alternate LINK

Title: Successful Treatment Of Fungal Endophthalmitis Using Intravitreal Caspofungin

Subject: Ophthalmology

Journal: Arquivos Brasileiros de Oftalmologia

Publisher: GN1 Genesis Network

Authors: Ciprian Danielescu, Alina Cantemir, Dorin Chiselita

Published: 2017-01-01

Everything You Need To Know

What is fungal endophthalmitis, and why is it significant?

Fungal endophthalmitis is a severe eye infection, accounting for a portion of endophthalmitis cases. It's considered rare but can cause significant vision loss. Its significance lies in the need for effective treatments, especially when dealing with resistant strains. The implications of this infection include the potential for vision impairment or loss, which is why prompt and effective treatment is crucial.

What were the initial symptoms observed in the patient's eye?

The symptoms observed in the case included ciliary injection, which is redness around the iris; inflammation in the anterior chamber, the space between the cornea and the iris; and hypopyon, a collection of pus in the anterior chamber. These symptoms indicate a severe inflammatory response within the eye, which is typical of endophthalmitis. The implications of these symptoms are that they signal the presence of a serious infection that requires immediate medical intervention to prevent vision loss.

What is Stephanoascus ciferrii, and what makes it significant in this case?

Stephanoascus ciferrii is an unusual yeast-like fungus that was identified as the cause of the infection in the case. Its significance is amplified by its resistance to common antifungals. The implication is that conventional treatments would likely fail, necessitating a novel therapeutic approach like intravitreal caspofungin to combat the infection effectively.

What is intravitreal caspofungin, and why is it important in treating this infection?

Intravitreal caspofungin involves injecting the antifungal directly into the vitreous cavity of the eye. This method is important because it allows for a high concentration of the drug to reach the infection site directly, bypassing systemic absorption, which may be less effective in the eye. In this particular case, it proved successful when traditional treatments such as fluconazole, voriconazole, and amphotericin B failed. The implications here are that direct administration can be a successful treatment strategy for resistant fungal infections.

When traditional treatments fail, what alternative therapy offers hope?

When common antifungal treatments such as fluconazole, voriconazole, and amphotericin B fail, the case highlights an alternative, intravitreal caspofungin. The significance of this is that it presents a treatment option for otherwise untreatable infections. The implication is that this approach provides a pathway to preserve sight, offering hope for patients who are resistant to standard antifungal medications.