Endogenous Candida endophthalmitis. Management without intravenous amphotericin B.
Eight consecutive cases of culture-proven endogenous Candida endophthalmitis (ECE) were managed between 1980 and 1988. All patients were treated with vitrectomy and injection of intravitreal amphotericin B. Blood cultures were negative in all patients, although Candida albicans was cultured from a foot ulcer in one patient. No systemic therapy was used in three patients, three patients received oral ketoconazole, and two patients received oral flucytosine postoperatively. Intravenous amphotericin B was not used because of lack of evidence of disseminated candidiasis and the systemic toxicity associated with its use. The ECE responded favorably to treatment in all cases. Final vision was better in patients with a shorter interval between onset of symptoms and initiation of antifungal therapy. Posttreatment visual acuities were: four eyes greater than or equal to 20/50, two eyes at 20/80 to 20/200, and two eyes less than 5/200. This series showed that ECE without evidence of disseminated disease can be treated successfully with vitrectomy and intravitreal amphotericin B.
Brod
R D
RD
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, School of Medicine.
Flynn
H W
HW
Clarkson
J G
JG
Pflugfelder
S C
SC
Culbertson
W W
WW
Miller
D
D
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D009877:Endophthalmitis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000382:microbiology
D000666:Amphotericin B; D005437:Flucytosine; D007654:Ketoconazole