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K. Urban, M.M. Lai, G. Williams, L.A. Stec; The Use of Intravitreal Voriconazole as a Surgical Adjunct in the Treatment of Fungal Endophthalmitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5286.
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To report an unusual presentation of endogenous fungal endophthalmitis, and its successful management using intravitreal voriconazole as a novel surgical adjunct.
Interventional case report of a patient who presented with prominent anterior segment findings of endogenous fungal endophthalmitis who underwent complete ophthalmologic evaluation and microbiological analysis. Treatments included topical and systemic antifungal therapy as well as surgical intervention with pars plana vitrectomy, lensectomy, and intravitreal injection of voriconazole. In addition, we conducted a review of the literature relevant to the current treatment of fungal endophthalmitis including intravitreal antifungal medications.
A 39–year–old female with a history of total parenteral nutrition (TPN) status post colectomy for Crohn’s Disease presented with decreased visual acuity and fluffy white infiltrates involving the iris and anterior lens capsule in the left eye. A diagnosis of endogenous Candida albicans endophthalmitis was made based on positive blood cultures and anterior chamber serology. Despite treatment with topical natamycin, intravenous (IV) fluconazole and IV liposomal amphotericin B, her vision continued to decline, the anterior segment fungal infiltrate continued to enlarge, and a hypopyon developed. Therefore, she underwent pars plana vitrectomy, lensectomy, and removal of anterior segment infiltrate with concomitant intravitreal injection of voriconazole (100µg/0.1mL). Postoperative examination disclosed improved vision and no evidence of active fungal infection. The patient continued to experience visual improvement and remained free of recurrent fungal infection at one month of follow–up. No clinical evidence of toxicity from intravitreal voriconazole was observed.
Endogenous fungal endophthalmitis from Candida albicans can present with prominent anterior segment findings. Resistance to systemic therapy is an indication for surgical intervention. Intravitreal voriconazole can be used as a surgical adjunct to safely and effectively treat fungal endophthalmitis. To our knowledge, this is the first reported case of intravitreal voriconazole used as an adjunct in the surgical management of endogenous fungal endophthalmitis. With the emergence of resistance to current standards of antifungal therapy, the development of novel treatment methods is crucial for the successful management of fungal endophthalmitis.
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