ESCRS - FP20.04 - Culture Vs Molecular Detection In Fungal Endophthalmitis: Evidence From A Postoperative Cluster

Culture Vs Molecular Detection In Fungal Endophthalmitis: Evidence From A Postoperative Cluster

Published 2026 - 44th Congress of the ESCRS

Reference: FP20.04 | Type: Free paper | DOI: 10.82333/pf22-r350

Authors: Dr Dr.Navaneeth Saggam* 1 , Dr Siddharth Narendran 1

1Aravind Eye Hospital,Coimbatore,India

Purpose

To compare the diagnostic yield and turnaround time of conventional culture with molecular detection methods, including a CRISPR-based assay (RID-MyC) and pan-fungal PCR, in a postoperative Candida pelliculosa endophthalmitis cluster using intraocular lens (IOL)–capsular bag culture as the reference standard.

Setting

Observational case series conducted across two tertiary referral centers (Aravind Eye Hospital, Madurai and Coimbatore, Tamil Nadu, India) during management of a postoperative fungal endophthalmitis cluster originating from a single source hospital (October–November 2024).

Methods

Consecutive patients meeting a predefined cluster case definition after cataract surgery were included. At presentation, standardized vitreous and/or aqueous humor samples were obtained before intravitreal therapy. Specimens were divided for conventional microbiology (direct microscopy and culture on blood, chocolate, and Sabouraud’s agar) and molecular testing (in-house pan-fungal PCR and CRISPR-based RID-MyC assay). Explanted IOL–capsular bag complexes underwent culture only. Sensitivity was calculated per sample using IOL–bag culture as the reference standard. Turnaround time (TAT) was defined as the interval from specimen collection to first laboratory-reported result.

Results

Twelve eyes from ten patients were included. Seventeen intraocular fluid samples (3 aqueous, 14 vitreous) were analyzed. All 12 explanted IOL–capsular bag complexes grew Candida pelliculosa, confirming fungal etiology.

Conventional aqueous/vitreous fluid culture was positive in only 2 of 17 samples (11.8%). In contrast, RID-MyC detected fungal DNA in all 17 samples (100%), and pan-fungal PCR in 16 of 17 (94%). The single PCR-negative specimen was RID-MyC positive.

RID-MyC results were available within 24 hours. Vitreous culture required 7 days, and IOL–bag culture required a mean of 3.5 days (range 2–7). From clinical presentation, mean time to positive result was 2 days (range 1–6) for RID-MyC and 10.4 days (range 2–35) for culture

Conclusions

In this confirmed postoperative Candida pelliculosa cluster, conventional intraocular fluid culture demonstrated low sensitivity (11.8%), whereas molecular assays showed markedly higher diagnostic yield, with RID-MyC achieving 100% detection and rapid (<24-hour) turnaround.

In the unique context of fungal endophthalmitis, a sterile, sequestered intraocular compartment where organisms may localize within the capsular bag, CRISPR-based molecular diagnostics provide substantial advantages in sensitivity and speed. Standardization and multicenter validation are warranted to support formal integration of molecular platforms into future diagnostic algorithms and consensus definitions for ocular fungal infections.