Intravitreal corticosteroids in the treatment of exogenous fungal endophthalmitis.
A rabbit model of exogenous Candida albicans endophthalmitis was used to determine if intravitreal corticosteroids combined with an efficacious antifungal agent enhanced fungal proliferation and ocular destruction, or if the combination can suppress the inflammatory and immunogenic response that causes retinal and uveal destruction. Exogenous Candida albicans endophthalmitis was experimentally induced in 20 rabbit eyes. Eight eyes received intravitreal amphotericin B alone; eight eyes received amphotericin B plus dexamethasone. Four eyes served as controls. By clinical grading on the fourth day after infection, the vitreous of the eyes in the two drug-treated groups was significantly clearer in comparison to that of eyes in the control group. By the seventh day after infection, the eyes treated with amphotericin B plus dexamethasone had significantly clearer vitreous in comparison to the eyes receiving only amphotericin B (P = 0.0017). Quantitative culture results were negative in both treatment groups, and histopathologic examination confirmed the clinical grading. Contrary to current beliefs, there was no evidence that the addition of corticosteroids impaired antifungal activity or enhanced fungal proliferation.
Coats
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ML
Associated Retinal Surgeons, Sarasota, FL 34239.
Peyman
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GA
D000666:Amphotericin B / Q000627:therapeutic use*; D000818:Animals; D002177:Candidiasis / Q000188:drug therapy* / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000473:pathology; D005654:Fundus Oculi; D007267:Injections; D011817:Rabbits; D014822:Vitreous Body
D003907:Dexamethasone; D000666:Amphotericin B