Pars Plana Vitrectomy and Intravitreal Liposomal Amphotericin B in the Treatment of Candida Endophthalmitis

Koç, Aylin; Onal, Sumru; Yenice, Özlem; Kazokoğlu, Haluk

doi:10.3928/15428877-20100215-35

Cited by 14 publications

(6 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…On histologic examination, increasing grades of vitreal inflammation and retinal damage were detected along with increasing doses, but there was no significant difference among eyes with 3 different agents [14]. Koç et al [5] reported clinical application of intravitreal L-AMB injection for the first time in 2010. They reported a case of bilateral Candida albicans endophthalmitis successfully treated with intravitreal 5 μg/0.1 mL L-AMB injection combined with vitrectomy in addition to systemic fluconazole therapy [5].…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Traditionally, amphotericin B (AMB) has been used as a first-line drug for intravitreal injection of antifungal drugs, but there are still concerns about retinal toxicity [4]. Recently, the usefulness of intravitreal injection of liposomal AMB (L-AMB), which has significantly improved systemic toxicity profile while retaining an antifungal effect compared to conventional AMB deoxycholate (AMB-D), for the treatment of OC caused by Candida albicans has been reported [5,6]. However, there is no report of intravitreal L-AMB injection for the treatment of OC caused by Candida glabrata.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multiple Intravitreal Liposomal Amphotericin B for a Case of Candida glabrata Endophthalmitis

Sakai¹,

Imai²,

Nakamura³

2021

Case Rep Ophthalmol

View full text Add to dashboard Cite

We report a case of Candida glabrata endophthalmitis which was effectively treated by intravitreal liposomal amphotericin B (L-AMB) injection. A 72-year-old man was referred to our department for positive blood culture of Candida glabrata. First ophthalmologic examination revealed a chorioretinal lesion in left eye, and the patient was diagnosed as possible candida chorioretinitis. Despite systemic antifungal therapy, his chorioretinal lesion increased in both eyes and complicated by vitritis. Intravitreal administration of L-AMB was introduced for probable candida endophthalmitis. Finally, improvement of vitritis and regression of chorioretinal lesions were obtained by total of 9 times intravitreal injection. Our case suggests the safety and efficacy of intravitreal L-AMB injection for Candida glabrata endophthalmitis.

show abstract

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multiple Intravitreal Liposomal Amphotericin B for a Case of Candida glabrata Endophthalmitis

Sakai¹,

Imai²,

Nakamura³

2021

Case Rep Ophthalmol

View full text Add to dashboard Cite

show abstract

“…C. retinitis can be treated in two ways: Liposomal amphotericin B formulation combined with flucytosine is used for advances lesions, cases with less serious severity can be treated with fluconazole. The recommended duration of therapy is at least 4 to 6 weeks [15]. When our case had developed sepsis, findings shown that there are no growing candida species in the blood cultures, however, we initiated empirically fluconazole along with antibacterial therapies.…”

Section: Case Descriptionmentioning

confidence: 91%

Candida Retinitis in a Liver Transplantation Recipient

Kose¹

2020

Int J Transplant Res Med

View full text Add to dashboard Cite

Introduction: Ocular candidiasis is one of the major complications of disseminated candidiasis in liver transplantation (LT) recipients. In this case report, it is aimed to present a patient developing candida retinitis in LT recipient in the first month after LT and successfully recovered with liposomal amphotericin B therapy. Case presentation: A 52-year-old male patient had been undergone right lobe LT from a living donor. He had diabetes mellitus and underwent serial erythrocyte and thrombocyte transfusions, the score of models for end-stage liver disease (MELD) was 23. On the 14 th day, biliary leakage and infected bilioma determined in multislice abdominal tomography. On the 25 th day, sepsis symptoms such as fever, tachycardia and hypotension developed. Leukocytosis, elevated C-reactive protein (CRP) and procalcitonin were also present. It was started empirically imipenem/cilastatin, teicoplanin, and fluconazole intravenous therapy. In the three blood cultures taken from fever presence, Enterobacter spp. Enterococcus faecium and Candida albicans (caspofungin-sensitive, fluconazole-resistant, MIK level > 256 µg/ ml) respectively were identified. According to the antimicrobial susceptibility test, fluconazole was discontinued and anidulafungin treatment was initiated. On the third day of anidulafungin treatment, the patient having the complaints of headache, decrease in visual acuity. Ophthalmology consultation was requested, as a result of ocular examination candida retinitis was diagnosed in the right eye. There were two focal yellow retinal lesions thought to be candidal plaques in retina and macula. Because of not successful to reach higher concentrations in cerebral tissues, the anidulafungin treatment was altered to liposomal amphotericin B. The antifungal treatment was also administrated intravitreal. The blood culture was sterile at the day of fourteen. All of the complaints downgraded, and the retinitis symptoms recovered at the end of 28-day treatment. So, antifungal treatment was discontinued because of normal ocular examination. Conclusions: LT recipients have a high risk of disseminated candidiasis, the ophthalmological examination should never be neglected because candida retinitis is a common variant of disseminated candidiasis.

show abstract

“…Intravitreous injection of 5 to 10 g of amphotericin B is a widely used treatment for fungal endophthalmitis. While amphotericin B is an irritant, intravitreal liposomal amphotericin B is well tolerated in monkey and rabbit eyes and has been used in the treatment of Candida endophthalmitis (16,27,28). Another broad-spectrum antifungal agent administered intravitreally for treatment of fungal endophthalmitis is voriconazole, which inhibits the fungal enzyme cytochrome P450 demethylase.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to voriconazole, fluconazole also penetrates well into the vitreous, and both agents have been effective in treating fungal endophthalmitis through intravenous administration (14,15). Intravitreal injection of liposomal amphotericin B, which has less toxicity than amphotericin B, was used to treat a patient with bilateral endogenous Candida endophthalmitis (16).…”

mentioning

confidence: 99%

Pharmacokinetics and Safety of Intravitreal Caspofungin

Shen

Liang

Wang

et al. 2014

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Caspofungin exhibits potent antifungal activities against Candida and Aspergillus species. The elimination rate and retinal toxicity of caspofungin were determined in this study to assess its pharmacokinetics and safety in the treatment of fungal endophthalmitis. Intravitreal injections of 50 g/0.1 ml of caspofungin were administered to rabbits. Levels of caspofungin in the vitreous and aqueous humors were determined using high-performance liquid chromatography (HPLC) at selected time intervals (10 min and 1, 2, 4, 8, 16, 24, and 48 h), and the half-lives were calculated. Eyes were intravitreally injected with caspofungin to obtain concentrations of 10 g/ml, 50 g/ml, 100 g/ml, and 200 g/ml. Electroretinograms were recorded 4 weeks after injections, and the injected eyes were examined histologically. The concentrations of intravitreal caspofungin at various time points exhibited an exponential decay with a half-life of 6.28 h. The mean vitreous concentration was 6.06 ؎ 1.76 g/ml 1 h after intravitreal injection, and this declined to 0.47 ؎ 0.15 g/ml at 24 h. The mean aqueous concentration showed undetectable levels at all time points. There were no statistical differences in scotopic a-wave and b-wave responses between control eyes and caspofungin-injected eyes. No focal necrosis or other abnormality in retinal histology was observed. Intravitreal caspofungin injection may be considered to be an alternative treatment for fungal endophthalmitis based on its antifungal activity, lower retinal toxicity, and lower elimination rate in the vitreous. More clinical data are needed to determine its potential role as primary therapy for fungal endophthalmitis.

show abstract

Pars Plana Vitrectomy and Intravitreal Liposomal Amphotericin B in the Treatment of Candida Endophthalmitis

Cited by 14 publications

References 5 publications

Multiple Intravitreal Liposomal Amphotericin B for a Case of <b><i>Candida glabrata</i></b> Endophthalmitis

Multiple Intravitreal Liposomal Amphotericin B for a Case of <b><i>Candida glabrata</i></b> Endophthalmitis

Candida Retinitis in a Liver Transplantation Recipient

Pharmacokinetics and Safety of Intravitreal Caspofungin

Contact Info

Product

Resources

About