Intravitreal Injections of Voriconazole for Candida Endophthalmitis: A Case Series

Bienvenu, Anne‐Lise; Aussedat, M.; Mathis, Thibaud; Guillaud, M.; Leboucher, Gilles; Kodjikian, Laurent

doi:10.1080/09273948.2019.1571613

Cited by 13 publications

(6 citation statements)

References 14 publications

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“…Intravitreal antifungals were administered in 54% to 100% of eyes and were repeated in 33% to 50%. In a small case series of Candida endophthalmitis, intravitreal voriconazole (on average, four injections) was associated with a favourable clinical outcome [ 52 ]. Newer echinocandin antifungals may be effective against Candida resistant to azoles [ 1 , 53 ].…”

Section: Medical Treatmentmentioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

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Section: Medical Treatmentmentioning

confidence: 99%

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Danielescu

Anton

Stanca

et al. 2020

Journal of Ophthalmology

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“…Additionally, intravitreal administration of voriconazole has not been found to cause any ocular toxicity in studies in rats and in cultured human retinal pigment epithelium cells [ 11 , 12 ]. A recent case series in human patients who received up to 9 injections for Candida endophthalmitis also did not report any photoreceptor toxicity [ 13 ].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Treatment of Bilateral Endogenous Aspergillus Endophthalmitis with Multiple Intravitreal Voriconazole Injections with Good Visual Outcome

Aboobakar¹,

Ong²,

Nti³

et al. 2021

Case Rep Ophthalmol

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Endogenous endophthalmitis caused by Aspergillus species tends to be very aggressive, often leading to devastating visual outcomes. Historically, intravitreal amphotericin injections have played a central role in management, but with variable visual outcomes and a risk of toxicity. Limited reports suggest that use of intravitreal voriconazole is a safe and efficacious alternative, though these cases were treated with only few intravitreal injections. Here, we report a case of bilateral endogenous Aspergillus endophthalmitis treated with 8 intravitreal voriconazole injections in the right eye and 11 in the left eye with good best-corrected final visual outcome (20/50 right eye and 20/40 left eye).

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“…For ocular candida's location, our therapeutic choice was intravitreal injection of 100 ug/0.1 mL of off-label voriconazole, based on experimental studies in the literature. [7][8][9] After a single administration of voriconazole, completed without any noteworthy side effects, there was a notable clinical improvement with gradual vision recovery. Continuing the combination therapy between the two antifungals, the febrile episodes disappeared and the value of 1-3β-glucan reduced to the point of negativization in four consecutive measurements (<80pg/mL).…”

Section: Case Reportmentioning

confidence: 99%

Therapeutic Innovation for Multi-Resistant Candidemics: Synergy of Isavuconazole and Caspofungin Association

Duminuco¹,

Mauro

Palumbo

et al. 2021

Hematology Reports

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Fungal infections occurring in immunocompromised patients after immuno-chemotherapy treatment, are often difficult to eradicate and capable of even being fatal. Systemic mycoses affecting severely immunocompromised patients often manifest acutely with rapidly progressive pneumonia, fungemia, or manifestations of extrapulmonary dissemination. Opportunistic fungal infections (mycoses) include several pathogens elements, as Candidiasis, Aspergillosis, Mucormycosis (zygomycosis) and Fusariosis. Prompt diagnosis and effective therapy are needed to improve the associated morbidity and mortality, especially in cases with non-canonical fungal localizations and not responsive to the available antifungal drugs.

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Intravitreal Injections of Voriconazole for Candida Endophthalmitis: A Case Series

Cited by 13 publications

References 14 publications

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020

Treatment of Bilateral Endogenous <b><i>Aspergillus</i></b> Endophthalmitis with Multiple Intravitreal Voriconazole Injections with Good Visual Outcome

Therapeutic Innovation for Multi-Resistant Candidemics: Synergy of Isavuconazole and Caspofungin Association

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