Intravitreal voriconazole for the treatment of Aspergillus chorioretinitis

Abstract

The aim of this article is to report a case of Aspergillus chorioretinitis successfully treated with intravitreal voriconazole based on an interventional case report. An immunodeficient patient, 34 years old, receiving systemic antifungal treatment for 1 month for invasive aspergillosis with necrotizing pneumonia and brain metastasis, who presented with blurred vision in his left eye. Visual acuity (VA) was 20/20 in his right eye, and 8/20 in his left eye. Ophthalmological examination showed a paramacular nodular yellowish chorioretinal lesion with intraretinal hemorrhages, in the absence of vitritis or anterior uveitis. The patient was treated with one dose of intravitreal voriconazole (100 μg/0.1 ml). One week after the intravitreal injection, the patient's VA was 10/20, the retinal lesions had diminished, and the hemorrhages had disappeared. At 3-month follow-up, his AV was 20/20 with a residual retinal scar. The significant and rapid improvement in this patient suggests that early injection of intravitreal voriconazole may be the first therapeutic option in Aspergillus chorioretinitis, obviating the need for vitrectomy.

An Update on Voriconazole in Ophthalmology

“…36 Vila Arteaga J et al, in their case study had a significant and rapid improvement in patient treated with single dose of injection intravitreal voriconazole (100 μg/0.1 ml) for aspergillus chorioretinitis, obviating the need for vitrectomy. 37 Jang GJ et.al, successfully treated aspergillus chorioretinitis with systemic voriconazole. 38 …”

Histological Effects of Intravitreal Injection of Antifungal Agents in New Zealand White Rabbits: An Electron Microscopic and Immunohistochemical Study

“…Voriconazole is a second generation triazole which acts on the enzymes of the fungal cytochrome P450, preventing the synthesis of ergosterol in the cytoplasmic membrane, thus inhibiting fungal growth [ 1 , 14 , 16 , 17 ]. It has shown therapeutic efficacy against fungal keratitis and endophthalmitis after intrastromal, intracameral, intravitreal, intravenous, oral, and topical administration [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. It has strong biological activity against Candida , Aspergillus , Fusarium, and other filamentous fungal species [ 25 , 26 , 27 ].…”

A Comparative Treatment Study of Intravitreal Voriconazole and Liposomal Amphotericin B in anAspergillus fumigatusEndophthalmitis Model

“…Several studies have concluded that intravitreal VCZ could be a treatment strategy for fungal endophthalmitis. [8][9][10][11][12] Amphotericin B (Amp-B) is the treatment of choice for fungal endophthalmitis. Amphotericin B increases fungal membrane permeability and cell death by binding ergosterol.…”