FusariumEndophthalmitis following Cataract Surgery: Successful Treatment with Intravitreal and Systemic Voriconazole

Abstract

Purpose. To report a case of postoperative endophthalmitis caused by Fusarium species successfully treated with intravitreal and systemic voriconazole after treatment failure with amphotericin B. Methods. Clinical case report of a 60-year-old immunocompetent woman who presents with endophthalmitis of unknown origin 4 weeks after uneventful cataract extraction and IOL implantation surgery. IOL explantation, vitrectomy with capsular bag removal, vitreous aspiration for culture, and intravitreal injection of amphotericin B (5 μg/0.1 mL) were performed. Diagnosis was established by culturing the vitreous aspirate on a Sabouraud agar medium and staining with lactophenol blue solution. Five days later, there was no clinical response. The decision was made to administer a single dose of intravitreal voriconazole (2.5 μg/0.1 mL) and oral voriconazole (200 mg BID) for 30 days. Results. Fusarium sp. grew on culture. Treatment with local and systemic voriconazole was started after no improvement with vitrectomy, IOL explantation, and intravitreal amphotericin B. After 1 month of treatment, the infection resolved and best-corrected visual acuity was 20/25. Conclusion. In patients with endophthalmitis caused by Fusarium sp., topical and systemic voriconazole treatment should be considered in cases resistant to intravitreal amphotericin B.

An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea

“…Because most postoperative endophthalmitis shows bacterial etiology, antibacterial therapy is generally performed as an initial treatment for this condition. 5,6,9,13,17 However, aggressive antifungal therapy accompanied by vitrectomy was generally performed without delay in our patients owing to the prompt alarm raised by ophthalmology societies due to the nationwide fungal endophthalmitis outbreak.…”

“…5,13,18 However, many physicians also prefer to perform only 1 or 2 intravitreal injections, combined with long-term oral medications. 6,9,17 Although whether repeated intravitreal injections are essential for treating fungal endophthalmitis remains unclear, several investigators suggested its necessity to sufficiently control the infection. 18 Previously, Bui et al 18 performed early vitrectomy and repeated intravitreal injections of antifungal agents to treat filamentous fungal endophthalmitis.…”

“…Repeated intravitreal injection of antifungal agents is widely used to treat Fusarium endophthalmitis . However, many physicians also prefer to perform only 1 or 2 intravitreal injections, combined with long-term oral medications . Although whether repeated intravitreal injections are essential for treating fungal endophthalmitis remains unclear, several investigators suggested its necessity to sufficiently control the infection .…”

Use of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Diagnosis and Follow-Up of Endogenous Candida Endophthalmitis: a Case Report.

“…The vast majority of endophthalmitis cases have an exogenous origin. The infection may occur after intraocular surgical procedures (cataract surgery, trabeculectomy, intravitreal injections, keratoplasty), penetrating ocular trauma, or pathogen infiltration following infections of the cornea (keratitis, corneal ulcer) [3][4][5][6][7][8]. On the other hand, endogenous endophthalmitis is caused by the hematogenous dissemination of microorganisms from the primary site of inflammation [2,9,10].…”

VALUABLE APPLICATION OF THE β-d-GLUCAN TESTING OF INTRAOCULAR FLUID FOR THE DIAGNOSIS OF FUNGAL ENDOPHTHALMITIS

“…However, it is one of the most detrimental eye infections and may lead to irreversible blindness in the infected eye. 1 The etiology of FE varies depending on the pattern of infection. Fusarium spp.…”