Filamentous fungal endophthalmitis: results of combination therapy with intravitreal amphotericin B and voriconazole

Abstract

PurposeTo report outcomes of exogenous fungal endophthalmitis treated with combination of intravitreal antifungal agents.DesignRetrospective, non-randomized, interventional, consecutive case series.MethodsTwelve eyes of twelve consecutive cases of filamentous fungal endophthalmitis were treated with a combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy at a single center. Clinical characteristics, microbiology results, treatment strategy, visual, and anatomical outcomes were analyzed.ResultsTen cases out of the twelve were postoperative endophthalmitis of which nine were part of a post cataract surgery cluster. The remaining included endophthalmitis following keratitis post pterygium excision (1) and following open globe injury (2). The most common fungus was Aspergillus terreus, which was isolated in 8/12, followed by A. flavus in 2/12 and Fusarium solani in 1/12. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow-up was 20/400 or better in 7/12 eyes (58.33%) and 20/60 in 2/12 eyes (range 20/60 to LP). All eyes with corneal involvement had final visual acuity 20/400 or worse. Globe salvage was achieved in all cases.ConclusionCombining intravitreal amphotericin-B and voriconazole could be a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with corneal involvement had poor visual outcome either with or without therapeutic penetrating keratoplasty.

A Case of Bilateral Endogenous <b><i>Candida dubliniensis</i></b> Endophthalmitis Treated with Aggressive Local and Systemic Therapy

“…This approach resulted in good control of local disease. Daily intravitreal voriconazole and alternate day intravitreal amphotericin B combination has been previously used successfully for endophthalmitis caused by filamentous fungi [19], and recently for coccidioidal endophthalmitis [20].…”

Endogenous Aspergillus Endophthalmitis in an Immunocompetent Patient With a Remote History of Pulmonary Tuberculosis

“…Exogenous presentations have been reported after various forms of intraocular surgery (most often cataract surgery), trauma, and extension of fungal keratitis. 2 Endogenous forms are most commonly seen in IV drug abusers or in immunocompromised patients, particularly those who have undergone organ transplantation or aortic valve replacement surgery. 3,4 There seem to be only a few reported cases of endogenous Aspergillus endophthalmitis in immunocompetent patients.…”

“…1 It has also been reported in exogenous settings from intraocular surgery, trauma, or spread from keratitis. 2 Endogenous aspergillus endophthalmitis has very rarely been reported in immunocompetent patients.…”

Endoftalmitis infecciosa postraumática: reporte de caso

“…Es el caso de la diabetes mellitus, que causa una inmunosupresión ocasionada por la hiperglucemia constante y deriva en una disminución en la quiomiotaxis leucocitaria y, por ende, en una alteración en la liberación de citotoxinas, con una implicación directa sobre la funcionalidad fagocítica de los neutrófilos, los cuales tienen un protagonismo especial en la inmunidad humoral y la actividad antioxidante. Como se evidencia en varios estudios, la diabetes mellitus es un factor de riesgo significativo en el pronóstico de la enfermedad y en la agilidad en los procesos de intervención (12)(13)(14)(15)(16)(17). La evolución de esta patología fue rápida y el proceso infeccioso no cedió, pese a los múltiples esfuerzos del equipo multidisciplinario que participó en su manejo.…”