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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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Related in: MedlinePlus

(a) Fundus picture at first visit showing extensive vitreous exudation and string of beads appearance along with an active area of chorioretinitis; (b) Fundus picture at final follow-up shows a normal posterior pole with minimal vitreoretinal traction at the site of resolved chorioretinitis
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Figure 0002: (a) Fundus picture at first visit showing extensive vitreous exudation and string of beads appearance along with an active area of chorioretinitis; (b) Fundus picture at final follow-up shows a normal posterior pole with minimal vitreoretinal traction at the site of resolved chorioretinitis

Mentions: Within a week of starting oral voriconazole, his visual acuity improved to 20/80 and the media started clearing. The string of beads had started to break away and reduce in size. The fuzzy margins of the cotton-ball opacities and the chorioretinitis patch were becoming discrete. Oral voriconazole was continued for three weeks. After three weeks, the media cleared completely. Voriconazole and the topical medications were stopped. He was evaluated six weeks after stopping voriconazole. His visual acuity improved to 20/20 and N6 in the right eye. The string of pearls had completely disappeared and the chorioretinitis patch had healed [Fig. 2].


Successful management of presumed Candida endogenous endophthalmitis with oral voriconazole.

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

(a) Fundus picture at first visit showing extensive vitreous exudation and string of beads appearance along with an active area of chorioretinitis; (b) Fundus picture at final follow-up shows a normal posterior pole with minimal vitreoretinal traction at the site of resolved chorioretinitis
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: (a) Fundus picture at first visit showing extensive vitreous exudation and string of beads appearance along with an active area of chorioretinitis; (b) Fundus picture at final follow-up shows a normal posterior pole with minimal vitreoretinal traction at the site of resolved chorioretinitis
Mentions: Within a week of starting oral voriconazole, his visual acuity improved to 20/80 and the media started clearing. The string of beads had started to break away and reduce in size. The fuzzy margins of the cotton-ball opacities and the chorioretinitis patch were becoming discrete. Oral voriconazole was continued for three weeks. After three weeks, the media cleared completely. Voriconazole and the topical medications were stopped. He was evaluated six weeks after stopping voriconazole. His visual acuity improved to 20/20 and N6 in the right eye. The string of pearls had completely disappeared and the chorioretinitis patch had healed [Fig. 2].

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