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Nidhi Batra, Avinash Pathengay, kopal Mithal, Animesh Jindal, Divya Vira, Nagendra K Koday, Harry W Flynn; Combination Antifungal (intravitreal amphotericin-B and intravitreal voriconazole - AmB-Vo Regime) Therapy in treating filamentous fungal endophthalmitis at a tertiary eye care centre from South India. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4182.
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Retrospective analysis of outcomes of non-randomised, interventional, consecutive case series of exogenous filamentous fungal endophthalmitis cases treated with combination of intravitreal antifungals.
At a single centre, 12 eyes of 12 consecutive cases of endophthalmitis caused by filamentous fungi and treated with combination of intravitreal amphotericin-B and intravitreal voriconazole (AmB-Vo Regime) along with pars plana vitrectomy were identified and studied.
The etiologies of endophthalmitis were postoperative (10/12) and post traumatic (2/12). Of the 10 postoperative endophthalmitis cases, 9 were part of a cluster outbreak and the remaining postoperative case occurred after pterygium surgery. Aspergillus tereus was the most common fungus, which was isolated in 8/12 cases, followed by Aspergillus flavus in 2/12 cases and Fusarium solani in 1/12 cases. The presenting visual acuity ranged from light perception (LP) to counting fingers. The visual acuity at final follow up was 20/400 or better in 7/12 patients (58.33%) and 20/60 in 2/12 patients (Range 20/60 to LP). None of the eyes lost light perception or were enucleated. All of the 5 eyes with associated fungal keratitis had visual acuity 20/400 or worse at last follow-up.
Combination antifungal therapy (intravitreal amphotericin-B and voriconazole) along with pars plana vitrectomy, is a novel treatment strategy in the management of endophthalmitis caused by filamentous fungus. Eyes with associated fungal keratitis had poor visual outcomes with or without therapeutic penetrating keratoplasty. The current study significance is limited by the small number of cases, the retrospective data collection and the lack of a control group. However, an experimental study with concomitant in-vitro and in-vivo study setup for studying outcomes of combination antifungal therapy against filamentous fungal infections may reveal the possible synergism between the antifungal drugs.
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