Treatment of Endogenous Fungal Endophthalmitis With Systemic Fluconazole With or Without Vitrectomy

Laatikainen, Leila; Tuominen, M.; Dickhoff, Kai von

doi:10.1016/s0002-9394(14)71537-5

Cited by 30 publications

(15 citation statements)

References 3 publications

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“…15,16 MIC of different isolates usually differs due to dissimilarity in the genes encoding for the proteins conferring sensitivity to the anti-fungals. The sensitivity pattern in Aspergillus fumigatus differs in accordance to the pattern of cytochrome b gene sequences.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic fungal endophthalmitis—a prospective study

Gupta

Srinivasan

Kaliaperumal

et al. 2006

Eye

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Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin. Results Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 lg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better. Conclusions Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

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Section: Discussionmentioning

confidence: 99%

Post-traumatic fungal endophthalmitis—a prospective study

Gupta

Srinivasan

Kaliaperumal

et al. 2006

Eye

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“…Entretanto, o quadro clínico sistêmico e o risco anestésico do paciente impossibilitaram a realização da injeção intravítrea ou vitrectomia. Dentre as opções terapêuticas (28) , o fluconazol (40) apresenta-se altamente eficaz contra as espécies de Candida e de outros fungos, podendo ser administrado por via oral, na dosagem de 200 a 400 mg ao dia, ou por via intravenosa.…”

Section: Discussionunclassified

Uso do fluconazol endovenoso no tratamento da endoftalmite fúngica endógena: relato de caso

Dotto

Rodrigues

Fernandes³

et al. 2005

Arq. Bras. Oftalmol.

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“…Presently, there are anecdotal reports of patients who have been successfully treated for endogenous Candida endophthalmitis with fluconazole alone (6,11,12,26,28,40,43). In one of these cases, the endophthalmitis had been resistant to treatment with intravitreal amphotericin B and systemic ketoconazole but responded to treatment with oral fluconazole (6).…”

Section: Discussionmentioning

confidence: 99%

Treatment of exogenous Candida endophthalmitis in rabbits with oral fluconazole

Park

D’Amico

Paton

et al. 1995

Antimicrob Agents Chemother

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We investigated the efficacy of oral fluconazole, alone or in combination with oral flucytosine (5FC), in treating Candida endophthalmitis using a rabbit model. Albino rabbits were infected with an intravitreal inoculation of 1,000 CFU of susceptible Candida albicans and randomized 5 days later to receive treatment with oral fluconazole alone (80 mg/kg of body weight per day), a combination of fluconazole and 5FC (100 mg/kg/12 h), or no treatment. The treatment effect was assessed at 2 and 4 weeks after therapy by funduscopy, quantitative vitreous culture, and histopathology. Intravitreal levels of fluconazole, 2 to 24 h after the first dose, were measured to be >10 times the MIC of the drug for C. albicans. Among rabbits treated with fluconazole for 2 weeks, 67% had a >90% reduction in fungal load (P < 0.05) and 33% were sterile. After 4 weeks, all had a >99% reduction in fungal load (P < 0.05) and 75% were sterile (P ‫؍‬ 0.01). This treatment effect was unchanged 4 weeks after discontinuation of fluconazole. Among rabbits treated with fluconazole and 5FC for 2 weeks, 67% died during therapy. Among the surviving rabbits, 75% had a >90% reduction in fungal load (P < 0.05) and 25% were sterile. We conclude that oral fluconazole may be useful for treatment of Candida endophthalmitis. Addition of 5FC was associated with high toxicity and minimal additional antifungal effect in our rabbit model. Intraocular fungal infection can result from an exogenous inoculation of the microorganism, as in posttraumatic or postoperative endophthalmitis, or from an endogenous source, as in patients with fungemia. Fungal endophthalmitis accounts for 12% of all cases of infectious endophthalmitis and is a leading cause of endogenous infectious endophthalmitis (29). The most common cause of fungal endophthalmitis is Candida albicans.Traditionally, the commonly used therapy for fungal endophthalmitis consists of intravenous amphotericin B, used alone or in combination with vitrectomy and intravitreal injection of amphotericin B (1, 8, 14-16, 20, 22, 23). Although intravenous amphotericin B therapy is often effective for treatment of chorioretinitis associated with fungal endophthalmitis, treatment failure can occur in eyes with advanced endophthalmitis with marked vitreous infiltrates due to the poor penetration of the drug into the vitreous (8). In addition, systemic administration of the drug requires prolonged hospitalization and is associated with unpleasant and potentially dangerous side effects. Treatment efficacy for advanced endophthalmitis may be enhanced by combining systemic amphotericin B therapy with vitrectomy and intravitreal amphotericin B injections, but such procedures are associated with potential morbidity.For these reasons, the current advocated treatment for fungal endophthalmitis is controversial, and the therapy often is individualized on the basis of the severity of the endophthalmitis (8). In patients with endogenous Candida endophthalmitis without evidence of systemic infection, vitrectomy alone or vitrectomy...

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Treatment of Endogenous Fungal Endophthalmitis With Systemic Fluconazole With or Without Vitrectomy

Cited by 30 publications

References 3 publications

Post-traumatic fungal endophthalmitis—a prospective study

Post-traumatic fungal endophthalmitis—a prospective study

Uso do fluconazol endovenoso no tratamento da endoftalmite fúngica endógena: relato de caso

Treatment of exogenous Candida endophthalmitis in rabbits with oral fluconazole

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