Successful treatment of resistant ocular fusariosis with posaconazole (SCH-56592).
OBJECTIVE
To describe the successful treatment with systemic posaconazole of a series of Fusarium ocular infections refractory to other antifungal agents.


METHODS
Retrospective, interventional case series.


METHODS
We identified three patients from three different centers who received diagnoses of Fusarium keratitis and who received systemic posaconazole after their infections failed to respond to maximal tolerated medical and surgical therapy. All patients received multiple systemic, intracameral, and topical antifungal agents, which were ineffective in controlling their infection.


RESULTS
Two patients were contact lens wearers. Two patients developed endophthalmitis. The infections of all three patients failed to respond to systemic and/or topical voriconazole treatment. One patient could not tolerate systemic voriconazole, and another experienced no marked improvement. The third discontinued treatment for both reasons. All patients were treated with oral posaconazole and experienced rapid reduction of intraocular inflammation and pain, as well as resolution of the infection without additional intervention.


CONCLUSIONS
Deep Fusarium keratitis is difficult to treat and carries a high risk of progression to endophthalmitis. Posaconazole, which exhibits excellent tissue penetration and demonstrates efficacy in the treatment of systemic Fusarium infection, was successful in treating three cases of pan-resistant keratitis and/or endophthalmitis.
Tu
Elmer Y
EY
Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois, USA. etu@uic.edu
McCartney
David L
DL
Beatty
Richard F
RF
Springer
Kathryn L
KL
Levy
Jaime
J
Edward
Deepak
D
D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D005260:Female; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole