Topical Antimycotics in Ophthalmology

Behrens–Baumann, W.

doi:10.1159/000310884

Cited by 22 publications

(21 citation statements)

References 33 publications

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“…5 Since keratomycosis is a potentially devastating condition, rapid diagnosis and an efficient administration of appropriate antifungal therapy are mandatory to preserve visual function. 6,7 In our case, topical and systemic fluconazole administration gave excellent clinical results. Fluconazole, therefore, may be considered a good alternative to amphotericin B for the treatment of Candida keratitis, especially in the forms associated with C. lusitaniae infection.…”

Section: Discussionsupporting

confidence: 50%

Polymicrobial Keratomycosis in a Three-Year-Old Child

Parentin

Liberali

Perissutti

2006

Ocular Immunology and Inflammation

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Section: Discussionsupporting

confidence: 50%

Polymicrobial Keratomycosis in a Three-Year-Old Child

Parentin

Liberali

Perissutti

2006

Ocular Immunology and Inflammation

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“…For clinical reasons, combined treatment studies of antifungals and corticosteroids in rabbits have also been conducted [10] . Several studies were undertaken to evaluate ocular penetration of antifungals in healthy and infected rabbit eyes [11] . The observed ocular penetration of CAS in a rabbit model of uveitis with an impaired blood-eye barrier revealed that therapeutic levels of CAS within the eye may be obtained after systemic treatment.…”

Section: Discussionmentioning

confidence: 99%

Aqueous Humor Concentrations of Topically Administered Caspofungin in Rabbits

et al. 2008

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Background: The echinocandin caspofungin (CAS) is a novel antifungal drug with fungicidal in vitro activity against all Candida spp., which are the most frequent cause of fungal keratitis. Penetration of CAS through the cornea into the aqueous humor after topical administration was investigated. Methods: A CAS solution with a concentration of 7 mg/ml was applied onto each rabbit’s cornea. Drug application after corneal epithelium abrasion was processed in different time intervals: single application with aqueous humor sampling after 1 and 2 h. In addition, after continuous application of CAS every 30 min, aqueous humor concentrations of CAS after 1, 2 and 5 h were analyzed by liquid-chromatography tandem mass spectrometry. Results: Topical administration of CAS without corneal epithelium abrasion resulted in no detectable amounts of the drug in the aqueous humor. However, with corneal abrasion, after a single application, levels of 2.16 ± 1.57 μg/ml (n = 6) were reached after 1 h and then decreased to 1.76 ± 0.88 μg/ml (n = 2) after 2 h. After serial application every 30 min, the following intracameral levels of CAS were detected: after 1 h, 2.11 ± 1.09 μg/ml (n = 6); after 2 h, 4.94 ± 1.80 μg/ml (n = 5), and after 5 h, 3.45 ± 2.11 μg/ml (n = 6). Conclusion: In the aqueous humor, therapeutic drug levels can be reached that cover the MICs of most fungi after epithelial abrasion. To achieve a sustained high level of CAS as an effective antifungal therapy for corneal keratitis, CAS should be administered topically every 30 min after removal of the corneal epithelium.

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“…There are also additional classes of antifungals, most notably the allylamines (e.g., terbinafine) and the recently introduced candins (e.g., caspofungin) although the clinical use of these preparations is not widespread. The molecular weight of antifungal agents carries particular importance [11,12]. Agents with a molecular weight of more than 500 Da can barely penetrate the corneal epithelium because the force of friction increasingly reduces diffusion.…”

Section: Antifungal Agentsmentioning

confidence: 99%

“…The first is amphotericin B, which can be administered topically (as eye drops or ointment), by intraocular injection, or systemically. This agent represents the gold standard for systemic antifungal therapy [6,11]. The second agent is natamycin (also known as pimaricin), administered topically.…”

Section: The Polyenesmentioning

confidence: 99%

Pharmacotherapy of fungal eye infections

Manzouri

Vafidis

Wyse

2001

Expert Opinion on Pharmacotherapy

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Fungal eye infections are rare. Trauma associated with contamination by vegetative material, contact lens wear and long term corticosteroid use are common risk factors. The aims of treatment are to preserve visual function, which depends on the rapid diagnosis and efficient administration of appropriate antifungal therapy. This necessitates a clinical suspicion of fungal aetiology and the taking of appropriate smears and cultures as early as possible to identify the fungal organism. Currently there are three main classes of drugs available for use in fungal eye infections: polyenes, azoles as derivatives of imidazoles, and 5-fluorocytosine. Of the polyenes, amphotericin B, natamycin and nystatin are of clinical ophthalmic use. Based on better pharmacokinetic profiles and spectra of antifungal activity, the triazoles are the agents of choice. Successful treatment of fungal keratitis depends on early initiation of specific therapy consisting of topically-applied antifungal agents since topical administration is most likely to provide the best opportunity for achieving therapeutic corneal levels. Hence, the molecular weight of the various antifungal agents is of importance since it influences their ability to penetrate the corneal epithelium. Systemic administration may be necessary for resistant fungal ulcers. For fungal endophthalmitis, to preserve visual function and eliminate the fungal pathogen, topical, systemic and possibly intraocular antifungal therapy is used, although some do not recommend use of systemic agents for exogenous endophthalmitis.

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Topical Antimycotics in Ophthalmology

Cited by 22 publications

References 33 publications

Polymicrobial Keratomycosis in a Three-Year-Old Child

Polymicrobial Keratomycosis in a Three-Year-Old Child

Aqueous Humor Concentrations of Topically Administered Caspofungin in Rabbits

Pharmacotherapy of fungal eye infections

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