Original ArticleManagement of endogenous fungal endophthalmitis with voriconazole and caspofungin
Section snippets
Methods
A retrospective review of five patients with fungal endophthalmitis treated with new-generation antifungal agents was initiated after obtaining approval from the institutional review board. Postmortem intraocular voriconazole concentrations on a sixth patient without ocular infection will be reviewed as well. All patients were treated at the Barnes Retina Institute (St. Louis, Missouri, USA) and the Cullen Eye Institute (Houston, Texas, USA) from August 2003 to May 2004.
Patient 1
A 66-year-old woman with adenocarcinoma of the colon and an enterocutaneous fistula presented with Candida glabrata septicemia. She had been treated with fluconazole for 3 weeks before being transferred to the Barnes Jewish Hospital (St. Louis, Missouri, USA). She complained of visual decline in her right eye for several days. Ophthalmic examination of the this eye revealed a visual acuity of 20/70 with vitreous cell with a solitary subretinal yellow infiltrate. Examination of the left eye was
Discussion
Therapy of ocular mycotic infections can be difficult and prolonged. The difficulty in treatment is due to a combination of the growth characteristics of fungi, a scarcity of effective antifungal agents, and the poor tissue penetration of previously investigated agents. The most important therapeutic principle in endophthalmitis is early diagnosis and correct identification of the fungus, because early treatment is more likely to yield a better visual outcome.10
When reviewing this series, we
References (19)
- et al.
Toxicity of intravitreal injection of amphotericin B
Am J Ophthalmol
(1973) - et al.
Intravitreal amphotericin B toxicity
Am J Ophthalmol
(1974) Therapy of postsurgical fungal endophthalmitis
Ophthalmology
(1978)- et al.
In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens
Am J Ophthalmol
(2004) - et al.
Delayed-onset, bleb-associated endophthalmitis caused by Lecythophora mutabilis
Am J Ophthalmol
(2004) - et al.
Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis
Ophthalmic Surg Lasers
(1997) - et al.
Vitrectomy and systemic fluconazole for treatment of endogenous fungal endophthalmitis
Ophthalmic Surg Lasers
(1996) - et al.
Intraocular penetration of systemically administered antifungal
Curr Eye Res
(1985) - et al.
Ocular uptake of fluconazole following oral administration
Arch Ophthalmol
(1990)