Subretinal injection of amphotericin B using a 41‑gauge needle for refractory Candida albicans subretinal abscess: a case report and literature review

To report a case of refractory endogenous fungal endophthalmitis with subretinal abscess caused by Candida albicans , successfully treated with subretinal injection of amphotericin B using a 41‑gauge (G) needle during pars plana vitrectomy (PPV). A 70‑year‑old male with long‑term immunosuppression due to prednisone for ankylosing spondylitis, diabetes mellitus, and recent urinary tract infection with Candida albicans presented with bilateral endogenous endophthalmitis. The left eye developed a large subretinal abscess (4 × 5 disc diameters) temporal to the macula, without initial macular involvement. Despite repeated intravitreal voriconazole, amphotericin B and systemic fluconazole, the abscess progressed. The patient underwent PPV with subretinal injection of amphotericin B (5 µg/0.1 mL) using a 41G needle, followed by silicone oil tamponade in the left eye. Postoperatively, the subretinal abscess significantly regressed without further expansion. Inflammation was controlled, and the eye was salvaged. Subsequent silicone oil removal and epiretinal membrane peeling were performed. The patient eventually succumbed to systemic infection, but the ocular infection remained controlled. For refractory Candida subretinal abscess that failed to respond to systemic and intravitreal antifungals, direct subretinal administration of amphotericin B via a 41G needle offers a safe and effective minimally invasive option, avoiding large retinotomy‑related complications. The trial was registered with the Chinese Clinical Trial Registry (ChiCTR) under registration number ChiCTR2600128522(registered on 22/07/2026, retrospectively registered).