Successful treatment of Fusarium endophthalmitis with voriconazole and Aspergillus endophthalmitis with voriconazole plus caspofungin.
OBJECTIVE
To report successful treatment of exogenous Fusarium and Aspergillus endophthalmitis with new antifungal agents.


METHODS
Interventional case report.


METHODS
Treatment of two cases is reviewed.


RESULTS
A 64-year-old man developed post-cataract Fusarium moniliforme endophthalmitis. Infection persisted despite removal of the intraocular lens, three vitrectomies, and five intravitreal injections of amphotericin. Inflammation resolved and vision improved from 20/80 to 20/40 on 6 months of oral voriconazole. A 55-year-old man developed post-cataract intraocular inflammation. After three vitrectomies and removal of the intraocular lens, Aspergillus fumigatus endophthalmitis was diagnosed. Intravitreal amphotericin and systemic voriconazole were given, but one week later there were early signs of recurrence. Intravenous caspofungin was added and the eye improved. Caspofungin was continued for 6 weeks and voriconazole for 6 months. Vision improved from counting fingers to 20/80 at 6 months and 20/25 at 23 months.


CONCLUSIONS
Voriconazole is a promising new therapy for Fusarium and Aspergillus endophthalmitis. Caspofungin may act synergistically with voriconazole in treating Aspergillus endophthalmitis.
Durand
Marlene L
ML
Infectious Disease Service, Massachusetts Eye and Ear Infirmary (MEEI), 243 Charles Street, Boston, MA 02114, USA. mdurand@partners.org
Kim
Ivana K
IK
D'Amico
Donald J
DJ
Loewenstein
John I
JI
Tobin
Ellis H
EH
Kieval
Shalom J
SJ
Martin
Stephen S
SS
Azar
Dimitri T
DT
Miller
Frederick S
FS
Lujan
Brandon J
BJ
Miller
Joan W
JW
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents / Q000627:therapeutic use*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D000077336:Caspofungin; D002387:Cataract Extraction; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D054714:Echinocandins; D009877:Endophthalmitis / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy / Q000382:microbiology; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D019654:Lens Implantation, Intraocular; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D011183:Postoperative Complications; D011743:Pyrimidines / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D014821:Vitrectomy; D065819:Voriconazole
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole