amphotericin-b and Cataract

The aim of this study was to present the signs, symptoms, management, and outcome of a series of cases of cluster endophthalmitis caused by a multi-drug resistant fungus, Trichosporon.. This was a retrospective, non-randomized, consecutive interventional case series. Ten cases of postoperative endophthalmitis operated by a surgeon on three consecutive operation theater (OT) days presented 3-5 months after their surgery. All cases were microbiologically confirmed. The pathogen was found to be resistant to most antifungals, including amphotericin B. The cases had a latent period of around 45 days. Management of endophthalmitis included intravitreal injections, anterior chamber (AC) lavage, Pars Plana vitrectomy (PPV), posterior capsulotomy, IOL, and capsular bag removal. Multiple intravitreal injections were required due to recurrence of infections after initial improvement with voriconazole injections.. Structural integrity was maintained and infection-free status was achieved in all the eyes. The presenting vision ranged from 6/60 to PL (perception of light). Seven out of 10 had improvement in their final vision over the presenting vision. Final outcome of four patients had vision of 6/24 or better, 4 patients had vision in the range of 2/60 to 6/36 and 2 patients had PL.. Trichosporon can cause devasting infections even in the immunocompetent, especially in association with implants and catheters. Triazoles form the mainstay of treatment of Trichosporon infection due to the high susceptibility of the organism in vitro. A regimen including voriconazole and amphotericin B may prove to be the most effective. This is the first report of an outbreak of cluster endophthalmitis caused by Trichosporon.

Topics: Amphotericin B; Antifungal Agents; Cataract; Endophthalmitis; Eye Infections, Fungal; Humans; Retrospective Studies; Trichosporon; Vitrectomy; Voriconazole

An 85-year-old man developed chronic postoperative endophthalmitis after complicated cataract surgery. Visual acuity in the affected eye was hand movements. Slitlamp biomicroscopy showed a hypopyon, superonasal iris nodule, and marked vitritis. An anterior chamber washout, iris biopsy, and intravitreal amphotericin injection were performed. Panfungal polymerase chain reaction of anterior chamber and vitreous samples were positive for Penicillium citrinum. The iris biopsy showed hyphae on Grocott staining. Despite treatment, the patient's acuity deteriorated to light perception and he developed severe intractable pain requiring evisceration. Histological analysis showed diffuse infiltration of hyphae. Penicillium species are fungal organisms that are ubiquitous in the environment and can cause chronic endophthalmitis. They are commonly dismissed as culture contaminants. True infection is confirmed by histological demonstration of fungal invasion. Diagnosis can be aided by iris biopsy if iris nodules are present. Polymerase chain reaction testing was beneficial in identifying the causative organism and should be considered early in endophthalmitis cases. Despite intravitreal and systemic antifungal treatment, the visual prognosis for this condition is variable.. None of the authors has a financial or proprietary interest in any material or method mentioned.

Topics: Aged, 80 and over; Amphotericin B; Cataract; Cataract Extraction; Endophthalmitis; Eye Infections, Fungal; Humans; Male; Penicillium; Postoperative Complications; Vitrectomy

Here we report the first case of postoperative endophthalmitis due to Candida pelliculosa after cataract surgery. We describe the clinical management of this type of candida infection in the eye.. A 57-year-old Turk man was seen at our clinic at the end of the first postoperative month after cataract surgery. He presented with eye redness, pain and decreased visual acuity. His ophthalmologic examination revealed moderate tyndall and a mild flare in the anterior chamber. Hypopyon in the capsular bag posterior to the intraocular lens was seen in the second postoperative month. Despite topical and subconjunctival bacterial endophthalmitis treatment, there was no improvement in the clinical situation. Candida pelliculosa was isolated from a sample culture obtained from the anterior chamber. Oral fluconazole could not be administered because of increased liver enzyme levels and intravenous amphotericin B could not be administered because of an allergic reaction. Intraocular lens explantation, pars plana vitrectomy and anterior chamber lavage by rupturing the posterior wall of the microabscesses were performed. Intravitreal and intracameral amphotericin B injections were given four times in addition to surgical interventions. The patient has been followed for 2 years and his best-corrected visual acuity was 0.4 at the last visit.. Nearly 1 month after cataract surgery, a patient presented with eye redness and blurred vision, with corneal endothelial deposits, hypopyon in the capsular bag and microabscesses on the incision sites and corneal endothelium. Candida pelliculosa should be considered in patients showing these symptoms. Multiple intraocular amphotericin B (5 μg) administrations can be used safely even in cases with high sensitivity to systemic use. Rupturing the posterior wall of the abscesses on the corneal endothelium surgically with intraocular lens explantation and pars plana vitrectomy are recommended.

Topics: Amphotericin B; Anterior Chamber; Antifungal Agents; Candida; Cataract; Cataract Extraction; Contraindications; Endophthalmitis; Fluconazole; Humans; Injections, Intraocular; Lens Implantation, Intraocular; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications; Vitrectomy

To describe the clinical courses of patients who received intravitreal injections of highly concentrated amphotericin B deoxycholate for suspected fungal endophthalmitis.. Retrospective medical record review of 3 cases of intraocular toxicity from highly concentrated amphotericin B.. The first patient developed posttraumatic endophthalmitis and received an undiluted dose (500 μg) of amphotericin B. He developed severe intraocular inflammation and required a pars plana lensectomy, vitrectomy, and scleral buckle after developing a cataract and retinal detachment. Six years later, his visual acuity stabilized at 20/30. The second patient developed endogenous endophthalmitis and was treated with 5 intravitreal injections of amphotericin B and underwent 3 surgical procedures. The surgeon later discovered that the patient had received 55 μg of amphotericin B during the second injection. Three months after the injection, the patient's visual acuity was 20/60. The third patient developed chronic postoperative endophthalmitis following cataract extraction. He received 160 μg of amphotericin B and was immediately treated with a vitreous washout. Two years later, his visual acuity improved to 20/30. The vitreous culture results were negative in each case. A key finding was that the amphotericin B solution appeared to be yellow instead of nearly colorless.. We present 3 cases of intraocular toxicity from highly concentrated amphotericin B. In every case, the overly concentrated amphotericin B solution was yellow in color. Although severe noninfectious panophthalmitis resulted in every case, the visual acuity outcomes were good. Physicians should examine the color of amphotericin B solution prior to intraocular administration. If the solution appears to be yellow, the medication should not be injected.

Topics: Aged; Amphotericin B; Antifungal Agents; Cataract; Child; Deoxycholic Acid; Drug Combinations; Endophthalmitis; Eye Infections, Fungal; Humans; Intravitreal Injections; Male; Middle Aged; Mycoses; Retinal Detachment; Retrospective Studies; Visual Acuity; Vitreous Body

The purpose of this study was to report a case of Phomopsis fungal keratitis that was diagnosed 2 months after a rose thorn injury that occurred while gardening.. The authors conducted a retrospective case report with literature review.. Deep stromal keratitis with extension of hyphae through Descemet's membrane was treated by therapeutic keratoplasty combined with oral and topical antifungal medications. The causative organism, a Phomopsis species, was identified by culture of the surgical specimens. Phomopsis, a plant fungus, has not been previously reported as a cause of human fungal keratitis. One year after the initial surgery, visual rehabilitation was accomplished with a repeat cornea transplant and cataract extraction with return of vision to 20/25.. Advanced fungal keratitis can be successfully treated by a combination of surgery to debulk the infectious organisms and pre- and postoperative medical therapy. Prompt recognition of fungal keratitis will increase the likelihood of cure. Phomopsis species, ubiquitous plant fungi, can cause infectious keratitis in humans.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Ascomycota; Cataract; Cataract Extraction; Corneal Ulcer; Eye Infections, Fungal; Eye Injuries, Penetrating; Gardening; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Plant Diseases; Postoperative Care; Pyrimidines; Reoperation; Triazoles; Voriconazole

Fungal infections of the skin and deeper tissues of the periorbital region are quite rare. We report a case of a localized, deep periorbital necrotizing Fusarium infection in an otherwise healthy, elderly lady. Since the clinical features and histopathological findings of Fusarium infection are by no means characteristic, the definitive diagnosis was achieved with the help of microbiological examination of cultured organisms. A combined medical and surgical therapy led to adequate control of infection. To conclude, localized, deep periorbital necrotizing soft tissue infection by Fusarium in an immunocompetent lady is not reported in literature. One should have a high index of suspicion for emerging fungal pathogens in the differential diagnosis of necrotizing orbital or adnexal conditions, even in an immunocompetent patient. The histologic findings of septate, branching hyphae and vascular invasion cannot distinguish Fusarium species from various other moulds such as Aspergillus species; microbiologic studies are essential for confirming the diagnosis.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cataract; Clotrimazole; Communicable Diseases, Emerging; Eye Infections, Fungal; Female; Fusarium; Humans; Immunocompetence; Lens Implantation, Intraocular; Middle Aged

Topics: Adolescent; Amphotericin B; Biopsy; Candida albicans; Candidiasis; Cataract; Diagnostic Errors; Eye Diseases; Flucytosine; Heroin Dependence; Humans; Male; Visual Acuity; Vitreous Body

Topics: Amphotericin B; Animals; Cataract; Dose-Response Relationship, Drug; Female; Inflammation; Injections; Male; Necrosis; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Retinal Hemorrhage; Time Factors; Vitreous Body

Topics: Adult; Amphotericin B; Aspergillosis; Biopsy; Cataract; Cell Nucleus; Conjunctiva; Corneal Ulcer; Cytoplasm; Histiocytes; Humans; Injections; Male; Nystatin; Staining and Labeling; Vision, Ocular; Visual Acuity

Topics: Agglutination Tests; Amphotericin B; Antigens; Blindness; Cataract; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus; Culture Media; Humans; Hypertonic Solutions; Male; Methods; Middle Aged; Retinal Detachment; Rubber; Sucrose; Triamcinolone; Uveitis

Topics: Acremonium; Amphotericin B; Ascomycota; Candidiasis; Cataract; Cataract Extraction; Drug Therapy; Eye Diseases; gamma-Globulins; Griseofulvin; Humans; Mycoses; Nystatin; Postoperative Complications; Steroids; Toxicology