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Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole.

Biju R, Sushil D, Georgy NK - Indian J Ophthalmol (2009 Jul-Aug)

Bottom Line: Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency.We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole.Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

View Article: PubMed Central - PubMed

Affiliation: Ranjini Eye Care, Cochin, Kerala, India. drbijuraju@gmail.com

ABSTRACT
Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency. Voriconazole, a broad-spectrum triazole antifungal agent, attains therapeutically significant concentrations in the vitreous cavity after systemic administration. We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole. Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

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Regression of vitreous exudates following treatment with voriconazole (a) String of beads at first visit; (b) One week after starting voriconazole – note the spreading away of the “beads”; (c) At four weeks follow-up; (d) At first visit: note the extensive vitreous exudation and fuzzy margins of the chorioretinitis patch; (e) The margins of the lesion become discrete along with reduction in vitreous exudation one week after voriconazole. Note the focus of arteritis close to the lesion; (f) Lesion shows signs of scaring at eight weeks; (g) Complete resolution at final visit
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Figure 0001: Regression of vitreous exudates following treatment with voriconazole (a) String of beads at first visit; (b) One week after starting voriconazole – note the spreading away of the “beads”; (c) At four weeks follow-up; (d) At first visit: note the extensive vitreous exudation and fuzzy margins of the chorioretinitis patch; (e) The margins of the lesion become discrete along with reduction in vitreous exudation one week after voriconazole. Note the focus of arteritis close to the lesion; (f) Lesion shows signs of scaring at eight weeks; (g) Complete resolution at final visit

Mentions: His visual acuity was 20/100, N36 and 20/20, N6 in the right and left eye respectively. The anterior segment evaluation of the right eye showed 2+ cells and a sluggish pupil. The right eye was pseudophakic with a clear posterior capsule. The fundus evaluation showed multiple cotton-ball opacities in the vitreous and few had coalesced to a ‘string of beads” appearance [Fig. 1]. An area of active chorioretinitis and arteritis along the superotemporal arcade was noted. Slit-lamp biomicroscopy showed numerous vitreous cells. The clinical picture was typical of endogenous endophthalmitis in the right eye most probably due to Candida species.[1] Fundus evaluation of the left eye showed an old branch retinal vein occlusion with photocoagulation scars and changes suggestive of mild non-proliferative diabetic retinopathy.


Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole.

Biju R, Sushil D, Georgy NK - Indian J Ophthalmol (2009 Jul-Aug)

Regression of vitreous exudates following treatment with voriconazole (a) String of beads at first visit; (b) One week after starting voriconazole – note the spreading away of the “beads”; (c) At four weeks follow-up; (d) At first visit: note the extensive vitreous exudation and fuzzy margins of the chorioretinitis patch; (e) The margins of the lesion become discrete along with reduction in vitreous exudation one week after voriconazole. Note the focus of arteritis close to the lesion; (f) Lesion shows signs of scaring at eight weeks; (g) Complete resolution at final visit
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2712702&req=5

Figure 0001: Regression of vitreous exudates following treatment with voriconazole (a) String of beads at first visit; (b) One week after starting voriconazole – note the spreading away of the “beads”; (c) At four weeks follow-up; (d) At first visit: note the extensive vitreous exudation and fuzzy margins of the chorioretinitis patch; (e) The margins of the lesion become discrete along with reduction in vitreous exudation one week after voriconazole. Note the focus of arteritis close to the lesion; (f) Lesion shows signs of scaring at eight weeks; (g) Complete resolution at final visit
Mentions: His visual acuity was 20/100, N36 and 20/20, N6 in the right and left eye respectively. The anterior segment evaluation of the right eye showed 2+ cells and a sluggish pupil. The right eye was pseudophakic with a clear posterior capsule. The fundus evaluation showed multiple cotton-ball opacities in the vitreous and few had coalesced to a ‘string of beads” appearance [Fig. 1]. An area of active chorioretinitis and arteritis along the superotemporal arcade was noted. Slit-lamp biomicroscopy showed numerous vitreous cells. The clinical picture was typical of endogenous endophthalmitis in the right eye most probably due to Candida species.[1] Fundus evaluation of the left eye showed an old branch retinal vein occlusion with photocoagulation scars and changes suggestive of mild non-proliferative diabetic retinopathy.

Bottom Line: Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency.We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole.Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

View Article: PubMed Central - PubMed

Affiliation: Ranjini Eye Care, Cochin, Kerala, India. drbijuraju@gmail.com

ABSTRACT
Endogenous fungal endophthalmitis is most commonly caused by Candida species and usually occurs in patients with chronic diseases such as diabetes mellitus and renal insufficiency. Voriconazole, a broad-spectrum triazole antifungal agent, attains therapeutically significant concentrations in the vitreous cavity after systemic administration. We report, the successful management of presumed endogenous Candida endophthalmitis in a patient with multiple diseases and unstable systemic status with oral voriconazole. Though fungal endophthalmitis has been successfully treated with a combination of intravenous and intravitreal voriconazole, to the best of our knowledge this is the first report in ophthalmic literature (Medline Search) on the treatment of fungal endophthalmitis with only the oral route of administration of voriconazole.

Show MeSH
Related in: MedlinePlus