amphotericin-b and Endophthalmitis

To describe a case of bilateral endogenous cryptococcal endophthalmitis in an immunocompetent host and to review adjunctive ophthalmic imaging patterns and treatment.. A retrospective case report.. A 45-year-old female patient with two distinct presentations of endogenous cryptococcal endophthalmitis in each eye presented initially with progressive blurred vision in the left eye, beginning more than 10 years after a craniotomy with ventriculoperitoneal shunt. Complete ophthalmic imaging was conducted and compared with data from previous literature. Administration of amphotericin-B had poorly responded; however, consolidation of fluconazole resulted in disease stabilization.. Bilateral intraocular cryptococcal infection can present with two distinct patterns of posterior segment findings. A review of ophthalmic imaging patterns found consistency in some characteristics of A-scan ultrasonogram and fundus fluorescein angiogram. Besides conventional treatment, voriconazole is likely to play an important role in the management of cryptococcal endophthalmitis.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Endophthalmitis; Eye Infections, Fungal; Female; Fluorescein Angiography; Fundus Oculi; Humans; Immunocompromised Host; Injections, Intravenous; Intravitreal Injections; Middle Aged; Multimodal Imaging; Ultrasonography

Fusarium spp. are an uncommon cause of fungaemia in immunocompromised and neutropenic patients that may hematogenously disseminate to the eyes. Herein, we describe a patient with acute lymphoblastic leukaemia and a prior history of extensive corticosteroid exposure who developed disseminated Fusarium solani infection following chemotherapy despite posaconazole prophylaxis. She was successfully treated with combination liposomal amphotericin B and voriconazole, intraocular injections of voriconazole, topical amphotericin B and bilateral vitrectomy. We also review published literature describing the management of endogenous Fusarium endophthalmitis in immunocompromised hosts.

Topics: Amphotericin B; Antifungal Agents; Drug-Related Side Effects and Adverse Reactions; Endophthalmitis; Female; Fungemia; Fusariosis; Fusarium; Humans; Immunocompromised Host; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole

Sporotrichosis is an implantation mycosis caused by. To systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by. Case reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups.. From 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration.. Anterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas.

Topics: Administration, Ophthalmic; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Glucocorticoids; Humans; Intravitreal Injections; Male; Middle Aged; Risk Factors; Sporothrix; Sporotrichosis; Treatment Outcome; Visual Acuity; Voriconazole; Young Adult

Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidemia; Echinocandins; Echocardiography; Endocarditis; Endophthalmitis; Fluconazole; Humans; Intensive Care Units; Magnetic Resonance Imaging; Osteomyelitis; Voriconazole

A bibliographic search was conducted of cases of Candida endophthalmitis reported in Japan and overseas between 2000 and 2011, in the Japana Centra Revuo Medicina Website of Japan Medical Abstracts Society (domestic reports) and MEDLINE (overseas reports). The investigation yielded 42 reports in domestic journals (49 cases ; hereinafter referred to as domestic cases) and 39 reports in journals published overseas (46 cases ; hereinafter referred to as overseas cases). The isolation rate of Candida albicans in the domestic cases was 65.3%, and that in the overseas cases was 71.7%. The initial treatment for the Candida endophthalmitis was fluconazole (FLCZ) therapy in 51.0% of the domestic cases and 38.1% of the overseas cases. Domestic reports suggested the effectiveness of FLCZ therapy for stage II cases, and of vitrectomy for stage III and IV cases. Reports from overseas, on the other hand, suggested the effectiveness of amphotericin B (AMPH-B) or voriconazole (VRCZ) therapy for stage II cases, and of vitrectomy for stage III and IV cases.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endophthalmitis; Female; Fluconazole; Humans; Infant; Japan; Male; MEDLINE; Middle Aged; Pyrimidines; Severity of Illness Index; Time Factors; Treatment Outcome; Triazoles; Vitrectomy; Voriconazole; Young Adult

Cerebral Aspergillosis is the most lethal manifestation of infection due to Aspergillus species arising most commonly as hematogenous dissemination from a pulmonary focus, direct extension from paranasal sinus infection or direct inoculation through trauma and surgery of the central nervous system (CNS). Voriconazole is currently considered the standard of treatment of CNS aspergillosis with liposomal amphotericin B being the next best alternative. Neurosurgical resection of infected cerebral tissue in addition to antifungal therapy is frequently performed in patients with CNS aspergillosis to prevent neurological deficits and improve outcome. Aspergillus endophthalmitis may occur endogenously mostly from a pulmonary focus or exogenously following eye surgery or trauma. Although amphotericin B is still described as the primary therapy, voriconazole is increasingly considered the first line treatment of Aspergillus endophthalmitis. Vitrectomy is recommended in most cases of Aspergillus endophthalmitis.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Humans; Neuroaspergillosis; Pyrimidines; Triazoles; Vitrectomy; Voriconazole

Topics: Aged; Amphotericin B; Antifungal Agents; Caspofungin; Diabetes Mellitus, Type 2; Disease Susceptibility; Drug Resistance, Multiple, Fungal; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Glaucoma; Humans; Hypertension; Intravitreal Injections; Lipopeptides; Male; Phialophora; Pyrimidines; Triazoles; Vitrectomy; Voriconazole

Candida endophthalmitis is a sight-threatening manifestation of disseminated candidiasis. The occurrence of endogenous candida endophthalmitis in patients with candidemia has ranged from 0-45% in the published literature. In critically ill patients, it has even been associated with increased mortality. In recent years, use of newer antifungal therapies for invasive candidiasis has increased given the rise in infections with non-albicans species of Candida. To identify current practices of the management of endogenous candida endophthalmitis and relevant antifungal drug research in this disease state, we conducted a MEDLINE search (1967-2006) and bibliographic search of the English-language literature. Treatments for candida endophthalmitis have not been evaluated through well-designed, well-powered clinical trials. Data have mainly been presented in case reports, case series, animal studies, pharmacokinetic studies, and as small subsets of larger trials. Traditional systemic therapies have been amphotericin B with or without flucytosine or fluconazole. Cure rates with antifungal drugs alone appear to be much higher in patients with chorioretinitis than in endophthalmitis with vitreal involvement. Pars plana vitrectomy with or without intravitreal amphotericin B injections has been advocated particularly for patients with moderate-to-severe vitritis and substantial vision loss. Information on new antifungal agents for endophthalmitis is limited, despite increasing use in patients with candidemia. Voriconazole may be a particularly attractive agent to consider for infections with fluconazole-resistant, voriconazole-susceptible strains. The current patchwork of animal studies and small patient reports provide clinicians with some insight into the role of newer agents in the treatment of candida endophthalmitis. In general, it appears that chorioretinitis infections can be more readily cured with most systemic antifungal agents, whereas more aggressive treatment, often including vitrectomy with or without intra-vitreal antifungal administration, is needed for patients with endophthalmitis with vitritis.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Echinocandins; Endophthalmitis; Fluconazole; Flucytosine; Humans; Pyrimidines; Risk Factors; Triazoles; Voriconazole

To report a case of explosive fungal endophthalmitis after penetrating keratoplasty and to review additional published and unpublished cases to consider possible strategies for prevention.. Records of this patient with postkeratoplasty candidal endophthalmitis and previously reported cases of postkeratoplasty candidal endophthalmitis were reviewed. Additional information of 26 unpublished cases was obtained from the Eye Bank Association of America.. After standard keratoplasty, the patient developed precipitous endophthalmitis on the second postoperative day. Abundant contamination with Candida was found in the residual donor corneoscleral rim, and Candida albicans was isolated from the aqueous humor of the recipient. Despite therapy with local antimicrobial agents, intraocular amphotericin B, and systemic fluconazole, the patient had a poor outcome with hand-motion visual acuity. Of the 44 collected cases of postkeratoplasty candidal endophthalmitis, 40 (91%) had the same organism cultured from the donor rim or medium. Forty-three donor corneas had been preserved in cold storage medium at 4 degrees C. Of 15 cases in which the outcome was available, 9 (60%) resulted in visual acuity of 20/200 or worse.. Case reports confirm the occurrence of donor-to-host transmission of postkeratoplasty candidal endophthalmitis. Despite the low reported incidence, the poor prognosis of the affected eye in the ajority of these cases suggests the need for antifungal supplementation of cold preservation media and other preventative strategies.

Topics: Aged; Amphotericin B; Aqueous Humor; Candida albicans; Candidiasis; Combined Modality Therapy; Cornea; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Reoperation; Tissue Donors

We report the first case of clinically diagnosed endogenous endophthalmitis caused by Histoplasma capsulatum var. capsulatum in a patient with the acquired immune deficiency syndrome.. Interventional case report and literature review.. Pars plana vitrectomy and scleral buckling procedure in the left eye with intravenous and intravitreal amphotericin in both eyes.. The clinical features, culture results, visual outcome, and complications were studied.. This case demonstrates a bilateral endophthalmitis with severe subretinal exudation, choroidal granulomas, and intraretinal hemorrhage leading to exudative bilateral retinal detachments. Vitreous cultures grew H. capsulatum var. capsulatum. Treatment consisted of intravenous amphotericin, intravitreal amphotericin (both eyes), pars plana vitrectomy (left eye), and scleral buckling procedure (left eye) with resulting counting fingers vision (right eye) and 20/300 (left eye). Four cases of Histoplasma endophthalmitis have been reported previously, all of which had a documented history of disseminated histoplasmosis and resulted in enucleation.. H. capsulatum should be considered a possible etiologic agent of endophthalmitis, especially in patients with a history of disseminated histoplasmosis and/or immune deficiency.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Histoplasma; Histoplasmosis; Humans; Male; Retinal Detachment; Retinal Diseases; Scleral Buckling; Vitrectomy; Vitreous Body

Candidal endophthalmitis is a sight-threatening ocular infection that most frequently occurs as a complication of candidemia. While amphotericin B is considered the gold standard for the treatment of most invasive fungal infections, the optimal management of candidal endophthalmitis has not been determined. Fluconazole, a triazole antifungal agent, has been shown to be effective in the management of a number of invasive fungal infections in both immunocompromised and immunocompetent hosts. We describe the clinical features and outcomes for six patients with candidal endophthalmitis who were treated with fluconazole at our institutions, and we review 21 additional cases reported in the English-language literature. In total, fluconazole has been used as the sole therapy for candidal endophthalmitis in 14 patients; 16 eyes were infected. Endophthalmitis was cured in 15 of 16 eyes (94%), including five infections that were complicated by vitreitis. Successful treatment required the administration of fluconazole (100-200 mg po) daily for approximately 2 months. In addition, fluconazole has been used in combination with pars plana vitrectomy for the successful treatment of four cases of candidal endophthalmitis that were complicated by moderate to severe vitreitis. Fluconazole appears to be a safe and effective alternative or addition to conventional treatments for the management of candidal endophthalmitis. Prospective evaluation is required to more clearly define the role of this antifungal agent in the management of ocular infections due to Candida species.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Drug Administration Schedule; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome

Candida tropicalis is a well-documented pathogen affecting humans. There is limited clinical and experimental evidence that C. tropicalis causes hematogenous endophthalmitis. We report two cases of C. tropicalis endophthalmitis and review 12 cases reported in the literature. Clinical presentation was similar to that described for Candida albicans endophthalmitis. Therapy with amphotericin B, with or without flucytosine, resulted in resolution of the lesions except in one patient, for whom enucleation of the eye was necessary to control the infection. None of the patients were leukopenic.

Topics: Adult; Amphotericin B; Blood; Candida; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Humans; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Child; Disease Models, Animal; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Infant; Male; Middle Aged; Rabbits

Cryptococcus neoformans is an opportunistic fungus with a predilection for infecting the meninges. Ocular sequelae of cryptococcal infections of the CNS usually include cranial nerve palsies or papilledema secondary to increased intracranial pressure. Intraocular cryptococcosis occurs less frequently, and over the last 23 years, only 27 cases have been reported, including the case presented here. Intraocular infection was most often manifested by chorioretinal lesions and vitritis. Underlying diseases were detected in only 11 (41%) of the 27 patients. Of note, ocular lesions preceded symptomatic meningitis in six (27%) of 22 patients with CNS involvement. For seven patients, the diagnosis was made by histologic examination of specimens of aqueous or vitreous humor; for another eight patients, the diagnosis was made after enucleation or at autopsy. Ocular involvement frequently led to severe visual loss; return of vision to normal was unusual. Early recognition and treatment may improve outcome for these patients.

Topics: Aged; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Humans; Treatment Outcome

Disseminated candidiasis has become an important infection, particularly in immunocompromised and postoperative patients. Although serologic tests may, in some settings, facilitate a premortem diagnosis, the disease is usually diagnosed by comprehensive clinical evaluation. Detection of the relatively newly recognized peripheral manifestations of candidemia may be vital to early diagnosis: endophthalmitis, osteomyelitis, arthritis, myocarditis, meningitis, and macronodular skin lesions. Studies in patients with chronic mucocutaneous candidiasis and in-vitro manipulations have begun to elucidate normal immune defense mechanisms against Candida, including serum factors, phagocytosis, intracellular killing mechanisms, and lymphocyte function (particularly T cell). The primary drugs for the treatment of disseminated candidiasis are still amphotericin B or amphotericin B plus 5-fluorocytosine; the mainstay of therapy for chronic mucocutaneous candidiasis is amphotericin B. Other antifungals and immune system-stimulating modalities (transfer factor, thymosin, thymus epithelial cell transplantation, and levamisol) may be useful for chronic mucocutaneous candidiasis in some settings and deserve further evaluation.

Topics: Amphotericin B; Animals; Antifungal Agents; Arthritis; Brain Diseases; Candidiasis; Candidiasis, Cutaneous; Drug Therapy, Combination; Endophthalmitis; Humans; Immunotherapy; Leukocytes; Lymphocytes; Macrophages; Myocarditis; Osteomyelitis; Phagocytosis; Skin Diseases

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child; Child, Preschool; Endophthalmitis; Eye; Female; Humans; Immunosuppressive Agents; Infant; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Racial Groups; Sepsis; Sex Factors

Ocular candidiasis is a major complication of candidemia. The incidence, risk factors, and outcome of eye involvement during candidemia are largely unknown. We prospectively studied the ocular manifestations of candidemia in a large, worldwide, randomized multicenter trial that compared voriconazole with amphotericin B followed by fluconazole for the treatment of candidemia.. Nonneutropenic patients with blood cultures positive for Candida species were assigned treatment with voriconazole or with amphotericin B followed by fluconazole in a randomized 2:1 ratio. Dilated fundoscopy was performed in each patient at baseline, on day 7, at 2 and 6 weeks after the end of treatment (EOT), and, if clinically indicated, at 12 weeks after EOT.. Of 370 patients, 49 had findings consistent with the diagnosis of ocular candidiasis at baseline, and an additional 11 patients developed abnormalities during treatment, totaling 60 patients with eye involvement (16%). Of these patients, probable Candida eye infection was diagnosed in 40 patients (6 with endophthalmitis, 34 with chorioretinitis), and possible Candida eye infection in 20 (all with chorioretinitis). The duration of candidemia was significantly longer in patients with ocular candidiasis (median, 4 days; range, 1-18 days) compared with patients without ocular involvement (median, 3 days; range 1-26 days; log rank, P = .026). Therapy with either voriconazole (44 cases) or amphotericin B followed by fluconazole (16 cases) was successful in 65% of patients; outcome was not evaluable in 32% and was unfavorable in 3%.. Ocular involvement occurred in 16% of patients with candidemia; however, endophthalmitis was uncommon (1.6%). Treatment with either voriconazole or amphotericin B followed by fluconazole was successful for ocular candidiasis in most cases with follow-up.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidemia; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Incidence; Male; Middle Aged; Prospective Studies; Pyrimidines; Risk Factors; Triazoles; Voriconazole; Young Adult

To determine the incidence of hematogenous candida endophthalmitis in seriously ill patients given parenteral hyperalimentation fluids, 131 hyperalimented postoperative patients were prospectively evaluated. All patients were screened weekly for the development of chorioretinal lesions, blood cultures positive for Candida albicans, and signs and symptoms of candida infection. Thirteen (9.9%) of 131 patients developed chorioretinal lesions compatible with hematogenous candida endophthalmitis. Seven of the 13 patients with eye lesions had blood cultures positive for yeast, whereas only two of 118 without eye lesions had blood cultures positive for yeast (P less than 0.0005). Thus, the occurrence of eye lesions consistent with hematogenous candida endophthalmitis correlated with positive blood cultures for yeast and strongly suggested invasive candidiasis.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Chorioretinitis; Culture Media; Endophthalmitis; Gastrointestinal Hemorrhage; Humans; Intertrigo; Parenteral Nutrition; Parenteral Nutrition, Total; Urinary Tract Infections; Wound Infection

To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19).. This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described.. Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28 days (14-45); the mean time from discharge to onset of visual symptoms was 22 days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10 months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others.. Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.

Topics: Adult; Amphotericin B; COVID-19; Endophthalmitis; Eye Infections, Fungal; Female; Hospitalization; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome; Vitrectomy; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Diseases; Eye Infections, Fungal; Humans; Mucormycosis; Orbital Diseases

Topics: Amphotericin B; COVID-19; Critical Care; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Middle Aged; Steroids

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

To report a case of Coccidioides immitis endophthalmitis with severe vision loss and a return to excellent vision after aggressive intervention.. Case report.. A 41-year-old man with a history of solid organ transplantation who complained of floaters and decreased vision in the setting of disseminated Coccidioides infection was found to have presumed coccidioidal endophthalmitis with visual acuities of 20/20 in the right eye and 20/200 in the left eye. The patient was managed with intravenous amphotericin B, oral voriconazole, and intravitreal injections of amphotericin B and voriconazole in the left eye every three days. Five weeks after presentation, his visual acuity remained 20/20 in the right eye and improved to 20/40 in the left eye. The patient was transitioned to twice weekly intravitreal injections and oral voriconazole on hospital discharge. One week later, vision in the left eye decreased to 20/500 with worsening vitritis, prompting vitrectomy. Vision in the left eye subsequently improved to 20/30. Five weeks later, the patient developed a macula-on inferior rhegmatogenous retinal detachment in the left eye and underwent a second vitrectomy, with scleral buckle, laser, and gas injection. Vision in the left eye returned to 20/25. In total, the patient received 22 amphotericin B and 17 voriconazole intravitreal injections in the left eye with two vitrectomies. Vision in the right eye remained 20/20 throughout his treatment course. At four months after presentation, the patient remained on oral voriconazole with no evidence of active intraocular infection on examination.. Aggressive medical and surgical management can be successful in ocular conservation and restoration of vision in coccidioidal endophthalmitis. Very mild disease may be conservatively monitored and managed with systemic antifungal therapy alone. In severe disease, early diagnosis and prompt and aggressive use of systemic and intravitreal antifungals may spare panophthalmitis and preserve vision.

Topics: Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Humans; Intravitreal Injections; Male; Vitrectomy; Voriconazole

This study aimed to highlight the association of stellate neuroretinitis occurring secondary to endogenous candidemia.. We report an unusual presentation of endogenous Candida endophthalmitis as a stellate neuroretinitis in the setting of Cornelia de Lange syndrome.. A 34-month-old girl with severe Cornelia de Lange syndrome and a history of parenteral nutrition dependence requiring a chronic central venous catheter presented with bilateral endophthalmitis secondary to candidemia. In one eye, the endophthalmitis had the atypical presentation as a stellate neuroretinitis.. This case represents a unique association of stellate neuroretinitis secondary to Candida infection in a patient with Cornelia de Lange syndrome.

Topics: Administration, Ophthalmic; Amphotericin B; Antifungal Agents; Bacteremia; Candida albicans; Candidemia; Candidiasis; Child, Preschool; De Lange Syndrome; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Intravitreal Injections; Klebsiella; Klebsiella Infections; Retinitis; Voriconazole

To determine the intraocular penetration of amphotericin B (AMPH-B) after an intravenously injection of liposomal amphotericin B (L-AMB) in inflamed human eyes.. Seven eyes of 5 patients with fungal eye diseases (endophthalmitis in 6 eyes and keratitis in 1 eye) were treated with intravenous injections of 100-250 mg/day of L-AMB. Samples of blood, corneal button, aqueous humor, and vitreous humor were collected and assessed for AMPH-B.. The AMPH-B level in the cornea (604.0 μg/g) of the case with fungal keratitis exceeded the minimum inhibitory concentration. However, the levels in the aqueous and vitreous humors of the cases with fungal endophthalmitis were lower, e.g., 0.02 ± 0.01 μg/ml (0.09% of serum level) in the aqueous humor and 0.05 ± 0.08 μg/ml (0.17% of serum level) in the vitreous humor.. The AMPH-B levels administered intravenously were very low in the aqueous and vitreous humors. Our findings indicate that intravenous L-AMB can be considered only for patients with mild endogenous fungal endophthalmitis, e.g., isolated chorioretinitis without vitreous extensions.

Topics: Amphotericin B; Antifungal Agents; Endophthalmitis; Humans; Injections, Intravenous

Topics: Amphotericin B; Endophthalmitis; Female; Humans; Leishmania; Leishmaniasis; Middle Aged; Visual Acuity

To evaluate the optical coherence tomography (OCT) features of retinal lesions in Chinese patients with endogenous Candida endophthalmitis (ECE).. We performed a retrospective review of patients diagnosed with ECE at one medical center. The medical records of the patients including predisposing risk factors, treatment and visual acuity were reviewed. And we focused on the analysis of OCT images of retinal lesions before and after treatment.. A total of 16 Chinese patients (22 eyes) were included in this study. The most frequent predisposing risk factors were intravenous use of corticosteroids or antibiotics, lithotripsy for urinary calculi, and diabetes. After treatment, visual acuity was improved in 13 (59.1%) of the 22 eyes, and remained the same in the other 9 (40.9%) eyes. Pre-treatment OCT images obtained at presentation were available for 17 of the 22 eyes. Four types of the OCT manifestations of retinal lesions were identified: type 1 (subretinal macular lesions), type 2 (lesions are located in the inner retinal layer), type 3 (lesions involve the full-thickness retina and accompanied with macular edema), type 4 (sub-inner limiting membrane lesions). Pre-treatment OCT imaging of the 17 eyes revealed five as type 1, four as type 2, six as type 3, and two as type 4. After treatment, OCT images revealed epiretinal membrane and subretinal fibrosis as the most common post-treatment complications of ECE. Epiretinal membrane was detected in 2/4 type 2 lesions, in 4/6 type 3 lesions, and in 1/2 type 4 lesions, while subretinal fibrosis was mainly seen in type 1 lesions (4/5). Among the types, visual prognosis was best in eyes with type 2 lesions.. In this case series, the OCT manifestations of retinal lesions in ECE could be classified into four types. The post-treatment OCT manifestations were different in four types of lesions. We preliminarily found that the OCT morphology of retinal lesions was associated with the visual prognosis of ECE.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Asian People; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Fluorescein Angiography; Humans; Intravitreal Injections; Male; Middle Aged; Retinal Diseases; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy; Young Adult

Eye damage during invasive aspergillosis is rarely described and biological diagnosis remains challenging. Here we report the case of a heart transplant recipient with ocular aspergillosis complicating disseminated aspergillosis. Although voriconazole was rapidly given, a decrease in visual acuity of the right eye was consistent with endophthalmitis, resulting in an emergency vitrectomy. The diagnosis was rapidly confirmed: laboratory results showed the presence of Aspergillus fumigatus in a vitreous sample. A series of systemic antifungal medications (liposomal amphotericin B, caspofungin, and voriconazole), several liposomal amphotericin B ocular injections, and pars plana vitrectomy resulted in a limited positive clinical outcome. Interestingly although standard mycological follow-up procedures were negative, Aspergillus antigen testing gave an index of 5.92 on vitreous humour, thus a new intraocular injection of liposomal amphotericin B was performed and voriconazole reinitiated. Ten other vitreous samples from patients without fungal infections were also tested, all showing indexes below 0.25. Although larger studies are needed, this case illustrates that galactomannan testing of vitreous humour could be useful for the diagnosis of fungal endophthalmitis if these data are confirmed in other patients, in particular, if standard mycology is negative and PCR is not available.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Endophthalmitis; Eye Infections, Fungal; Female; Galactose; Humans; Male; Mannans; Middle Aged; Visual Acuity; Vitrectomy; Vitreous Body; Voriconazole

Two fungal endophthalmitis cases demonstrate safety and efficiency of intravitreal caspofungin as a new therapy option in fungal endophthalmitis.. The purpose of this study was to evaluate the intravitreal application of caspofungin for the treatment of fungal endophthalmitis because rising resistance to voriconazole and amphotericin B leads to a need for new antifungal therapy options.. Initially, both patients with fungal endophthalmitis underwent pars plana vitrectomy. Microbiological analysis revealed Aspergillus terreus and Candida dubliniensis, which both possess atypical resistance patterns. Caspofungin has a low bioavailability in the eye when given systemically. It was injected intravitreally into the eyes affected by fungal endophthalmitis. An injection of 100 μg of caspofungin in a volume 0.1 mL was applied repeatedly. Clinical parameters were recorded. Both eyes were stabilized by the treatment. Finally, the intraocular infections with atypical mycotic agents were eliminated. Visual acuity improved to 0.4 logMAR (20/50 Snellen) in the first case and to 1.0 logMAR (20/200 Snellen) in the second case. During the treatment course, we have not seen any toxic effects or damage of intraocular structures related to the intravitreal administration of caspofungin.. In summary, intravitreal caspofungin was effective and well tolerated in both cases. Therefore, caspofungin seems to be a safe and effective intravitreal alternative to voriconazole and amphotericin B in fungal endophthalmitis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Blood-Retinal Barrier; Candida; Candidiasis; Caspofungin; Endophthalmitis; Eye Infections, Fungal; Humans; Intravitreal Injections; Male; Visual Acuity; Vitrectomy; Voriconazole

Candida lusitaniae is an uncommon cause of candidiasis in humans. Ocular manifestations of C. lusitaniae infection have not been reported. C. lusitaniae is either intrinsically resistant to amphotericin B or can acquire such resistance. We describe a case of bilateral endophthalmitis due to C. lusitaniae bloodstream infection in a liver transplant patient with rectal cancer. The patient suffered fungemia and endophthalmitis and was treated with liposomal amphotericin B. The isolate was identified as C. lusitaniae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, the system based on biochemical tests, and sequencing of the internal transcribed spacer region. The minimal inhibitory concentrations were 0.06 μg/mL for amphotericin B and 2.0 μg/mL for fluconazole. Repeat blood cultures were negative and the endophthalmitis improved following treatment with liposomal amphotericin B. However, the treatment was changed to fluconazole due to nephrotoxicity. No recurrence occurred after completion of treatment.

Topics: Aged; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Candida; Candidemia; Candidiasis; Catheter-Related Infections; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Humans; Liver Transplantation; Male; Microbial Sensitivity Tests; Rectal Neoplasms; Risk Factors

Endogenous fungal endophthalmitis (EFE) caused by disseminated fusariosis is a rare condition that generally has a poor outcome, even with intensive therapy. Here, we describe a case in which this type of EFE was diagnosed with vitreous sampling and was successfully treated with 25-gauge vitrectomy and antifungals, including liposomal amphotericin B and voriconazole. A 16-year-old male patient undergoing treatment for acute myeloid leukemia complained of eye pain and blurred vision in his right eye. Treatment was initiated for a vitreous opacity, possibly associated with herpetic retinitis, but the patient worsened and he was referred to us. Right-eye visual acuity was limited to light perception. We suspected endogenous endophthalmitis and performed 25-gauge vitrectomy with antibiotic perfusion of ceftazidime, vancomycin, and voriconazole. Vitreous culturing revealed the presence of Fusarium solani species complex, and enhanced computed tomography revealed disseminated fusariosis lesions in the lung, spleen, and the soft tissue of the left upper arm. The patient received antifungal treatment with liposomal amphotericin B and voriconazole, and these conditions were eliminated. Visual acuity recovered to 20/400 after additional vitrectomy for tractional retinal detachment and was maintained at this level during the 6-month follow-up period. The success of our treatment allowed the capture of optical coherence tomography images of the retina during fusarium-associated endogenous endophthalmitis and the follow-up period. Furthermore, this case showed that immediate vitrectomy for suspected EFE and intensive treatment can lead to a good clinical outcome.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Dermatomycoses; Endophthalmitis; Fusariosis; Fusarium; Humans; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Splenic Diseases; Treatment Outcome; Vitrectomy; Voriconazole

Endophthalmitis is a rare infection of the vitreous and/or aqueous. It can be bacterial or fungal. Exogenous endophthalmitis is the most common form and results from direct inoculation of a pathogen after eye surgery or penetrating trauma. Endophthalmitis can also be endogenous, secondary to disseminated infection. Fungal endophthalmitis is associated with poor prognosis and treatment is difficult given the low penetration of most of the antifungal agents available and the emergence of resistant filamentous fungi like Fusarium. To our knowledge, we describe the first endogenous fungal endophthalmitis due to Fusarium dimerum, a ubiquitous pathogen found in soil and plants. A 71-year-old woman, diagnosed with acute myeloid leukemia, was hospitalized for surveillance after induction chemotherapy. Prophylaxis by antibiotics and posaconazole was ongoing when she complained of pain and decreased vision in the left eye. A voluminous chorioretinal abscess developed and after multiple sterile aqueous humour samples, only vitrectomy allowed diagnosis with fungal hyphae seen on May-Grünwald Giemsa stained smear and positive cultures. The fungus was identified as Fusarium dimerum. The treatment, that included intravitreal injections of voriconazole and amphotericin B associated with systemic administration of voriconazole, allowed complete control of the infection. The source of this infection could not be confirmed despite the discovery of several possible infection sites including a periungual whitlow on the left hand and a lesion on a nail, from which samples were negative in microbiology laboratories. Unfortunately, damages of the retina were too important and the patient did not recover sight of her left eye.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Endophthalmitis; Eye; Female; Fusarium; Humans; Hyphae; Immunocompromised Host; Leukemia, Myeloid, Acute; Treatment Outcome; Triazoles; Vitrectomy; Voriconazole

Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.

Topics: Adult; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Bees; Bites and Stings; Dexamethasone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Glucocorticoids; Humans; Itraconazole; Male; Scleritis; Vitrectomy; Vitreous Body

To determine the type of Candida species in ocular infections and to investigate the relationship of antifungal susceptibility profile to virulence factors.. Fifty isolates of yeast-like fungi from patients with keratitis, endophthalmitis, and orbital cellulitis were identified by Vitek-2 compact system and DNA sequencing of ITS1-5.8S-ITS2 regions of the rRNA gene, followed by phylogenetic analysis for phenotypic and genotypic identification, respectively. Minimum inhibitory concentration of six antifungal drugs was determined by E test/microbroth dilution methods. Phenotypic and genotypic methods were used to determine the virulence factors.. Phylogenetic analysis showed the clustering of all isolates into eight distinct groups with a major cluster formed Candida parapsilosis (n = 21), which was the most common species by both Vitek 2 and DNA sequencing. Using χ2 test no significant difference was noted between the techniques except that Vitek 2 did not identify C. viswanathii, C. orthopsilosis, and two non-Candida genera. Of 43 tested Candida isolates high susceptibility to amphotericin B (39/43, 90.6%) and natamycin (43/43, 100%) was noted. While none of the isolates produced coagulase, all produced esterase and catalase. The potential to form biofilm was detected in 23/43 (53.4%) isolates. Distribution of virulence factors by heat map analysis showed difference in metabolic activity of biofilm producers from nonbiofilm producers.. Identified by Vitek 2 and DNA sequencing methods C. parapsilosis was the most common species associated with eye infections. Irrespective of the virulence factors elaborated, the Candida isolates were susceptible to commonly used antifungal drugs such as amphotericin B and natamycin.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biofilms; Candida; Candidiasis; Child, Preschool; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Keratitis; Male; Microbial Sensitivity Tests; Middle Aged; Natamycin; Orbital Cellulitis; RNA, Fungal; RNA, Ribosomal; Sequence Analysis, DNA; Virulence Factors; Young Adult

To describe a case of Coccidioides endophthalmitis that resulted in a favorable visual outcome after a combined medical and surgical approach.. A 33-year-old previously healthy woman was referred for evaluation of dyspnea and left-sided vision loss, which began 3 months before, after a trip to Nevada. She was found to have a pulmonary cavitary lesion and fluffy white material in the anterior chamber. An aqueous and vitreous paracentesis grew Coccidioides species. She was managed medically with a total of 7 weekly intravitreal injections of amphotericin B and intravenous liposomal amphotericin B followed by transition to oral posaconazole. Seven months after presentation, to ensure ocular sterilization and to clear the visual axis, she underwent temporary keratoprosthesis implantation, anterior segment reconstruction, removal of a cyclitic membrane and the crystalline lens, pars plana vitrectomy, placement of a pars plana Ahmed drainage device, and penetrating keratoplasty.. After surgical intervention and with maintenance posaconazole therapy, the patient had resolution of her dyspnea and improved uncorrected (aphakic) vision with a clear corneal graft, quiet anterior chamber, and normal optic nerve and retina.. A combined medical and surgical approach resulted in a favorable visual outcome and avoided the need for enucleation.

Topics: Adult; Amphotericin B; Antifungal Agents; Aqueous Humor; Coccidioides; Coccidioidomycosis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Intravitreal Injections; Ophthalmologic Surgical Procedures; Treatment Outcome; Triazoles; Vitreous Body

To report the outcomes of primary transconjunctival 23-gauge (23-G) vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis (EFE).. Retrospective analysis of patients with EFE who underwent diagnostic transconjunctival 23-G vitrectomy at a tertiary referral center.. Nineteen eyes of 15 patients with EFE were included in the study. Four patients had bilateral and 11 patients unilateral disease. Sixteen eyes of 15 patients underwent 23-G vitrectomy to confirm the diagnosis using vitreous culture, polymerase chain reaction, and histopathologic examinations. All affected eyes were treated with intravitreal amphotericin B 5 µg/0.1 mL. Fourteen patients received additional systemic antifungal therapy. Diagnostic 23-G vitrectomy confirmed the diagnosis of EFE in 75% of the eyes (12/16). Candida was found to be a causative agent in 62.5% and Aspergillus in 12.5% of the eyes. Retinal detachment was the most common complication (42% of eyes).. EFE can be easily confirmed using primary 23-G vitrectomy.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Conjunctiva; Endophthalmitis; Eye Infections, Fungal; Female; Fungi; Humans; Intravitreal Injections; Male; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

To compare the safety and efficacy of intravitreal anidulafungin injection with voriconazole and amphotericin B (Amp B) in an experimental Candida endophthalmitis (CE) model.. Total clinical scores were significantly different between treatment groups and the control group (p < 0.05). On day 7 of the therapy, clinical scores of the anidulafungin group were found to be significantly lower when compared with the other therapy groups, while a significant improvement was observed in the eyes of rabbits in the anidulafungin group (p < 0.05). Also, microbiological scores of the anidulafungin group were lower than those of the control group (p < 0.05). Histopathological scores of the anidulafungin treatment group were significantly better than the voriconazole and control groups. Inflammation was evidently suppressed and marked retinal toxicity was not observed with anidulafungin.. This is the first study comparing the efficacy of anidulafungin with other antifungal agents. In this CE model, an intravitreal single dose of anidulafungin was shown to be noninferior to voriconazole and Amp B. As an alternative to Amp B or voriconazole, intravitreal anidulafungin is suggested as an effective antifungal agent for the treatment of CE.

Topics: Amphotericin B; Anidulafungin; Animals; Antifungal Agents; Candida albicans; Candidiasis; Conjunctiva; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Eye Infections, Fungal; Intravitreal Injections; Iris; Male; Rabbits; Vitreous Body; Voriconazole

To evaluate the visual outcomes following aggressive management of filamentous fungal endophthalmitis with prompt surgical intervention and oral and intravitreal voriconazole.. Retrospective chart review study of consecutive patients with culture- or biopsy-proven filamentous fungal endophthalmitis treated at an academic referral center. Clinical characteristics, treatment regimens, and visual outcomes were analyzed.. Included were 5 patients, 1 with endogenous endophthalmitis due to systemic fusariosis and 4 due to exogenous endophthalmitis (1 with Fusarium, 2 with Scedosporium apiospermum, and 1 with Glomerella spp.). On presentation, 1 patient had best-corrected visual acuity (BCVA) of 20/20. The remaining 4 patients had count-fingers to hand motion (HM) vision. All patients underwent immediate surgical intervention for infection control. All patients received oral or intravenous voriconazole and aggressive intravitreal voriconazole every 2-3 days initially. Intravitreal amphotericin was added if there was poor response to voriconazole alone. Three patients achieved a final BCVA of 20/20, 1 patient achieved BCVA of 20/50, and 1 remained HMs only.. Aggressive treatment of filamentous fungal endophthalmitis with early surgical intervention, systemic antifungal therapy, and frequent intravitreal injections of voriconazole can result in excellent visual outcomes in some patients.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Female; Fusarium; Humans; Intravitreal Injections; Male; Microbial Sensitivity Tests; Middle Aged; Phyllachorales; Retrospective Studies; Scedosporium; Treatment Outcome; Voriconazole; Young Adult

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

To describe the isolates and susceptibilities to antifungal agents for patients with culture-proven exogenous fungal endophthalmitis.. Noncomparative case series.. The clinical records of all patients treated for culture-proven exogenous fungal endophthalmitis at a university referral center from 1990 to 2010 were reviewed. Specimens initially used for diagnosis were recovered from the microbiology department and then underwent antifungal sensitivity analysis.. The antifungal susceptibilities of 47 fungal isolates from culture-positive fungal endophthalmitis are reported. Included are 14 isolates from yeast and 33 from mold. The mean (±standard deviation) minimum inhibitory concetrations (MICs) for amphotericin B (2.6 ± 3.5 μg/mL), fluconazole (36.9 ± 30.7 μg/mL), and voriconazole (1.9 ± 2.9 μg/mL) are reported. Presumed susceptibility to oral fluconazole, intravenous amphotericin B, intravitreal amphotericin B, oral voriconazole, and intravitreal voriconazole occurred in 34.8%-43.5%, 0-8.3%, 68.8%, 69.8%, and 100% of isolates, respectively.. Based on this laboratory study of isolates from exogenous fungal endophthalmitis, intravitreal voriconazole appears to provide the broadest spectrum of antifungal coverage and, as such, may be considered for empiric therapy of endophthalmitis caused by yeast or mold.

Topics: Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Fungi; Humans; Microbial Sensitivity Tests; Mycoses; Voriconazole

To report on a case of Histoplasma capsulatum endogenous endophthalmitis in an immunocompetent patient.. A 30-year-old patient was admitted with floaters and vision impairment of 1 month's duration. He had a history of adrenal insufficiency, together with nasal, septum, and soft palate lesions of 3 months; duration. Culture results from specimens of these lesions were positive for H capsulatum. He was human immunodeficiency virus negative and there was no evidence of immunodepression or history of immunosuppression. Fundus examination revealed multiple fluffy balls with a string of pearls appearance, 2+ vitreous haze, multiple foci of retinochoroiditis inferiorly in the peripheral retina, and a 6-disk area lesion of retinochoroiditis at the superotemporal periphery. Due to poor response to oral itraconazole, a vitrectomy was performed with an intraocular injection of amphotericin B 5 μg/0.1 mL and removal for a vitreous specimen for culture of bacteria and fungi.. Vitreous specimen culture of the yeast at 28°C grew a white filamentous fungus colony, which was again cultured in a brain heart infusion agar medium, where it developed hyaline septate hyphae with microconidia and circular macroconidia with double wall, which was stained with a lactophenol dye at microscopic examination. The macroscopic morphology was consistent with H capsulatum.. Although endogenous H capsulatum endophthalmitis is a rare entity, it should be considered as a possible etiology even in apparently immunocompetent hosts, especially in patients with history of disseminated disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Chorioretinitis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Immunocompromised Host; Injections, Intraocular; Male; Vitrectomy; Vitreous Body

Intermediate uveitis is a subset of intraocular inflammation where vitritis is the most consistent sign, with or without snowball opacities or snow banks over the pars plana. Some patients will have an associated underlying systemic disease such as sarcoidosis, multiple sclerosis, ocular tuberculosis, inflammatory bowel disease, possibly Behçet's disease and intraocular lymphoma, whereas some will be classified as pars planitis in case of the lack of an identifiable systemic disease association. Our patient, a 47-year-old woman, developed intermediate uveitis after cataract surgery in her right eye, was misdiagnosed as pars planitis, and received steroid monotherapy for 8 months. Her inflammation only fully resolved after vitrectomy with removal of the intraocular lens (IOL) and capsular bag. Oral fluconazole and intravitreal amphotericin B injection had failed to resolve her inflammation when Candida albicans was identified as the cause of her persistent intermediate uveitis.

Topics: Administration, Oral; Amphotericin B; Candida albicans; Cataract Extraction; Diagnostic Errors; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Intravitreal Injections; Middle Aged; Pars Planitis; Postoperative Complications; Steroids; Treatment Outcome; Uveitis, Intermediate; Vitrectomy

To evaluate the outcomes of intravitreal liposomal amphotericin B (L-AmB) for treatment of endogenous candida endophthalmitis.. Medical records of four patients with endogenous candida endophthalmitis treated with intravitreal L-AmB injection alone or combined with vitrectomy were reviewed.. Endogenous candida endophthalmitis developed in two patients after gastrointestinal surgery, in one patient with sepsis, and in one patient undergoing systemic chemotherapy for metastatic breast cancer. Three eyes of two patients exhibited toxic uveitis following repetitive intravitreal injection of amphotericin B deoxycholate (AmB-D, 10 μg/0.1 ml). The other patients had general health issues that restricted the use of AmB-D due to the potential risk of systemic toxicity. Seven eyes underwent intravitreal injection of L-AmB (10 μg/0.1 ml) with or without vitrectomy. In these patients, intraocular inflammation and vitreous opacities resolved, and chorioretinal infiltrates evolved into fibrotic scars. Visual acuity improved and stabilized in all eyes during the follow-up period.. Intravitreal L-AmB seems to be well tolerated and effective in the treatment of endogenous candida endophthalmitis, and may be a reasonable alternative for patients who cannot endure the side effects or toxicity associated with conventional AmB-D therapy.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Intravitreal Injections; Male; Middle Aged; Visual Acuity; Vitrectomy; Vitreous Body

To compare the effects of voriconazole (VCZ) and liposomal amphotericin B (Amp-B) in an experimental model of Aspergillus fumigatus endophthalmitis.. Thirty guinea pigs received an intravitreal injection of A. fumigatus to induce endophthalmitis. The animals were randomly divided into three groups, including control (0.02 mL balanced salt solution intravitreal injection) and experimental (20 μg VCZ/0.02 mL or 20 μg liposomal Amp-B/0.02 mL intravitreal injection) groups. Corneal opacity, aqueous flare, and vitreous opacity were graded, and electroretinographic examinations were performed at multiple time points. At 28 days post treatment, histopathology was performed to examine the retinal architecture.. The inflammation in the VCZ and liposomal Amp-B groups was milder than that in the control group. Corneal opacity, aqueous flare, and vitreous opacity scores, as well as electroretinographic recording, showed significantly less inflammation in the VCZ group compared with the liposomal Amp-B group during the early and middle stages of endophthalmitis (P < 0.05). Normal histologic structure of the retina was observed in eyes treated with VCZ and liposomal Amp-B.. Both intravitreal VCZ and liposomal Amp-B were effective treatments for A. fumigatus-induced endophthalmitis in guinea pigs. Voriconazole was superior to liposomal Amp-B at doses similar to the initial therapy for acute infections. Further experimental and clinical studies are required to confirm the efficacy of these two antifungal drugs. Chinese Abstract.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Disease Models, Animal; Electroretinography; Endophthalmitis; Eye Infections, Fungal; Guinea Pigs; Intravitreal Injections; Voriconazole

Endogenous endophthalmitis is a rare and severe intraocular infection which can be vision-threatening. We describe a case of bilateral fungal endogenous endophthalmitis in a 64-year-old male which was successfully treated with systemic administration of fluconazole followed by pars plana vitrectomy with an intravitreous injection of amphotericin B.

Topics: Administration, Intravenous; Administration, Oral; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Humans; Intravitreal Injections; Male; Middle Aged; Treatment Outcome; Vitrectomy

To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy.. Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series.. Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. 'Anatomical success' defined as preserved anatomy of the globe, and absence of signs of inflammation. Functional success defined as an attached retina and a best corrected visual acuity of better than 20/400.. Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re - PPV (median follow-up, 37 months). Pre-study defined criteria for successful 'anatomical' and 'functional' outcomes were achieved in 83.3% and 50% respectively.. This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Female; Follow-Up Studies; Humans; Intravitreal Injections; Male; Middle Aged; Recurrence; Retrospective Studies; Surgical Wound Infection; Treatment Outcome; Visual Acuity; 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

Topics: Adult; Amphotericin B; Antifungal Agents; Buprenorphine; Candidiasis; Endocarditis; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Flucytosine; Hepatitis C, Chronic; Heroin Dependence; Humans; Male; Mycoses; Pneumonia, Staphylococcal; Recurrence; Shock, Cardiogenic; Substance Abuse, Intravenous; Tricuspid Valve; Ultrasonography

To determine the incidence, clinical features, and outcomes of infectious endophthalmitis after Boston Type 1 Keratoprosthesis (KPro) implantation.. Retrospective, consecutive case series. Chart review of 105 patients (126 eyes) who had KPro implantation at Cincinnati Eye Institute between November 2004 and November 2010 and who were followed up for at least 1 month (range, 1 month to 66 months; mean 25 months) revealed 3 cases who developed infectious endophthalmitis.. One patient had a history of congenital glaucoma, and 2 patients had Stevens-Johnson syndrome. Two had KPro implantation for penetrating keratoplasty failure and 1 had necrosis of a previous KPro cornea. The incidence of endophthalmitis was 2.4%. All patients wore a contact lens and were on vancomycin and a fourth-generation fluoroquinolone (moxifloxacin). Vitreous fluid cultures yielded Ochrobactrum anthropi, Candida parapsilosis, and Candida albicans. All patients received intravitreal amphotericin, vancomycin, and/or ceftazidime. Topical and oral antiinfective agents were tailored based on sensitivities. One patient required KPro removal and therapeutic penetrating keratoplasty. Vision did not recover for 2 patients who presented with vision decreased to light perception. One patient, who presented with decreased vision of 20/400, recovered to 20/60.. Infectious endophthalmitis is a devastating complication that can occur after Boston KPro implantation even with prophylactic vancomycin, a fourth-generation fluoroquinolone, and a therapeutic contact lens. Fungal and gram-negative organisms are a growing cause for concern. Further study is needed on optimal prophylaxis regimens, including the use of antifungals, especially for high-risk eyes, such as those with autoimmune cicatrizing disease.

Topics: Administration, Oral; Aged; Amphotericin B; Artificial Organs; Candida albicans; Candidiasis; Ceftazidime; Cornea; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Infections, Fungal; Female; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Incidence; Intravitreal Injections; Middle Aged; Ochrobactrum anthropi; Postoperative Complications; Prostheses and Implants; Prosthesis Implantation; Reoperation; Retrospective Studies; Vancomycin; Vitreous Body; Young Adult

Disseminated sporotrichosis occurs in individuals with impaired cellular immunity, such as in cases of neoplasia, transplantation, diabetes, and especially, acquired immunodeficiency syndrome. This report presents a 32-year-old Brazilian human immunodeficiency virus (HIV)-infected patient who developed a protracted condition of disseminated sporotrichosis with endocarditis, bilateral endophthalmitis, and lymphatic involvement. He needed cardiac surgery to replace the mitral valve. Sporothrix brasiliensis isolates were recovered from cultures of subcutaneous nodules and mitral valve fragments. Species identification was based on classical and molecular methods. The patient received amphotericin B for 52 days and subsequently, oral itraconazole. He remains asymptomatic, and he is on maintenance therapy with itraconazole. Despite his positive clinical outcome, he developed bilateral blindness. To our knowledge, this case is the first report of endocarditis and endophthalmitis caused by S. brasiliensis.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Brazil; Endophthalmitis; Eye; HIV; Hospitalization; Humans; Itraconazole; Male; Sporothrix; Sporotrichosis; Treatment Outcome; Vision, Ocular

The occurrence of endogenous Candida endophthalmitis is rare in immunocompetent patients. We report a case of a 29-year-old healthy woman who developed endogenous Candida endophthalmitis after normal spontaneous vaginal delivery. The patient was diagnosed with Candida endophthalmitis by positive vitreous culture obtained by diagnostic vitrectomy. After vitrectomy, she was treated with systemic and intravitreal antifungal therapy, and subsequently, her visual acuity recovered to 20/20 without other complications. Normal spontaneous vaginal delivery may cause endogenous Candida endophthalmitis in young healthy women. Diagnostic vitrectomy with systemic and intravitreal antifungal treatment can be useful in diagnosis and treatment of Candida endophthalmitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endophthalmitis; Female; Fluconazole; Humans; Intravitreal Injections; Postpartum Period

Spondylodiscitis is an inflammatory disease, usually infectious, of one or more vertebral bodies and of corresponding intervertebral discs. The fungal aetiology is rare (less than 5% of cases), affecting mostly immunocompromised individuals. It is often a delayed diagnosis by the indolence of symptoms, presenting itself as a serious infection, which may result in important functional consequences. The authors present the case of a 75-year-old male, with constitutional complaints and intense back pain. Prior recent history of left hemicolectomy due to diverticulitis with multiple surgical complications, resulted in prolonged intensive care unit hospitalisation, and, later on, an episode of fungal endophthalmitis. The diagnosis of spondylodiscitis L5/S1 was performed by MRI. The patient underwent surgical disco-vertebral debridement and isolation of a Candida albicans was seen in the collected surgical material. No evidence of an immunossupressive status was found. Treatment was complemented with liposomal amphotericin B in the maximum recommended dose.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Combined Modality Therapy; Debridement; Diagnosis, Differential; Discitis; Endophthalmitis; Humans; Magnetic Resonance Imaging; Male

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Cornea; Corneal Injuries; Endophthalmitis; Eye Foreign Bodies; Eye Infections, Fungal; Eye Injuries, Penetrating; Humans; Keratoplasty, Penetrating; Male; Middle Aged; Mycoses; Sclera; Ultrasonography; Visual Acuity; Vitreous Body; Young Adult

To compare in vitro susceptibility of amphotericin B (AMB) and amphotericin B methyl ester (AME) (a more soluble and less toxic formulation of AMB) against Candida albicans isolates recovered from human cases of endophthalmitis.. The in vitro susceptibility of AMB and AME was determined for C. albicans isolates recovered from endophthalmitis (N=10) and for C. albicans ATCC reference strain 90028 using the Clinical and Laboratory Standards Institute M27-A2 (NCCLS/CLSI) broth dilution method. All isolates were obtained from samples of vitreous humor of patients with suspected endophthalmitis within the last 5 years at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Miami, FL).. The minimal inhibitory concentrations (MICs) of AME were equal to or lower than values for AMB in 7 of the 10 isolates; range: AME (0.125-1 μg/mL) versus (0.5-1 μg/mL) for AMB. The MIC(90) value of both drugs was equal (1 μg/mL). Compared with AMB, the minimal fungicidal concentrations (MFCs) of AME were equal to or lower in 8 of 10 isolates; range: AME (0.125-2 μg/mL) versus AMB (0.25-4 μg/mL). MFC(90) values of AME (1 μg/mL) was slightly superior to AMB (2 μg/mL). The MIC of the quality control strain (ATCC(®) 90028) was within an acceptable range.. AME was equivalent to AMB in vitro against C. albicans. This formula may offer a slightly more efficient and less toxic formulation for the treatment of Candida endophthalmitis.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Humans; Microbial Sensitivity Tests; Solubility; Vitreous Body

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Corneal Transplantation; Corneal Ulcer; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Microscopy, Acoustic; Middle Aged; Mycoses; Phialophora; Pyrimidines; Recurrence; Triazoles; Voriconazole

The occurrence of infections due to previously rare opportunistic pathogens is increasing despite the use of novel treatment strategies for immunocompromised patients. Here, we report the case of a patient presenting with fever, muscle pain, and bilateral endophthalmitis after allogeneic hematopoietic stem cell transplantation. Fusarium solani was isolated from peripheral blood samples and identified as the cause of gradual bilateral vision loss, despite appropriate antifungal prophylaxis, and therapy including vitrectomy and intraocular instillation of antifungal agents. The patient became comatose; basal meningitis involving both optic nerves was suspected based on magnetic resonance tomography. The patient died 8 days later due to septic multi-organ failure. Autopsy revealed that both kidneys, but no other organs, were infiltrated by Fusarium. No fungus was found in cerebral tissues or cerebrospinal fluid. Our case demonstrates some of the typical clinical features of systemic fusariosis and its potentially fatal outcome. The clinical observations reported here may help clinicians caring for immunocompromised patients to accelerate diagnosis and initiate treatment early at the onset of this fatal complication, and highlight the urgent need for interdisciplinary management of invasive fusariosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Fusariosis; Fusarium; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Male; Transplantation, Homologous; Triazoles

Topics: Abscess; Aged; Amphotericin B; Ascomycota; Cataract Extraction; Combined Modality Therapy; Drug Therapy, Combination; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Female; Humans; Mycoses; Pyrimidines; Recurrence; Triazoles; Vitrectomy; Vitreous Body; Voriconazole

Topics: Administration, Inhalation; Aged; Amphotericin B; Anti-Asthmatic Agents; Asthma; Candidemia; Candidiasis, Oral; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Glucocorticoids; Humans; Nystatin; Risk Factors

The purpose is to report an eye with endogenous Aspergillus flavus endophthalmitis that achieved a good visual outcome following early and aggressive management.. A 76-year-old male recently hospitalized for allergic Aspergillus pneumonitis after cleaning out a grain bin presented with reduced vision and anterior chamber and vitreous inflammation. The patient was treated with intravenous amphotericin and a pars plana vitrectomy with intravitreal amphotericin, and the vitreous biopsy sent for histopathological and microbial analysis.. A. flavus was isolated from the vitreous biopsy. Two weeks after vitrectomy, intravitreal amphotericin was again injected into the affected eye. The patient regained vision to 20/80 several months later, despite a moderate cataract.. Early treatment of A. flavus endophthalmitis with pars plana vitrectomy, intravitreal and systemic amphotericin can lead to good visual outcomes.

Topics: Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Aspergillosis; Aspergillus flavus; Endophthalmitis; Farmer's Lung; Humans; Inflammation; Injections, Intraocular; Injections, Intravenous; Male; Treatment Outcome; Vision, Low; Vision, Ocular; Visual Acuity; Vitrectomy; Vitreous Body

The goal of this study was to compare in vitro and in vivo efficacy of moxifloxacin and liposomal amphotericin B (Amp-B) monotherapies and combination treatment against Candida albicans in an exogenous endophthalmitis model in rabbit eyes. Microplate dilution tests and checkerboard analysis were performed to detect in vitro efficacies. Endophthalmitis was induced by intravitreal injection of C. albicans in 40 rabbit eyes with simultaneous intravitreal drug injection according to prophylactic treatment groups. Group 1 (control group) received 0.1 mL of balanced salt solution, group 2 (moxi group) 100 microg moxifloxacin/0.1 mL, group 3 (Amp-B group) 10 microg liposomal Amp-B/0.1 mL, and group 4 (combi group) both 100 microg moxifloxacin/0.1 mL [DOSAGE ERROR CORRECTED] and 10 microg liposomal Amp-B/0.05 mL intravitreally. Clinical examination, quantitative analysis of microorganisms, and histopathologic examination were performed as in vivo studies. The minimum inhibitory concentration of liposomal Amp-B against C. albicans was found to be 1 microg/mL. Moxifloxacin showed no inhibition of in vitro C. albicans growth. The minimum inhibitory concentration values of liposomal Amp-B for C. albicans were reduced two- to eightfold with increasing concentrations of moxifloxacin in vitro. In vivo, there was no C. albicans growth in the combi group (zero of eight eyes), whereas three eyes (37.5%) showed growth in the Amp-B group. Vitreous inflammation, retinal detachment, focal retinal necrosis, and outer nuclear layer loss were found to be lower in the moxi group compared with the control group. Ganglion cell and inner nuclear layer loss was observed in all eyes (100%) in both the moxi and combi groups, whereas only in 25% (two of eight eyes) in the Amp-B group. Moxifloxacin strongly augments the efficacy of liposomal Amp-B against C. albicans in vitro, although it has no in vitro antifungal activity when used alone. It is interesting that we found a synergistic effect for in vitro tests but failed to demonstrate it in vivo. When 100 microg moxifloxacin/0.1 mL is given intravitreally, it has some toxic effects that are limited to the inner retinal layers.

Topics: Amphotericin B; Animals; Antifungal Agents; Aza Compounds; Candida albicans; Candidiasis; Colony Count, Microbial; Disease Models, Animal; Drug Resistance, Fungal; Drug Therapy, Combination; Endophthalmitis; Eye Diseases; Eye Infections, Bacterial; Eye Infections, Fungal; Fluoroquinolones; Microbial Sensitivity Tests; Moxifloxacin; Quinolines; Rabbits; Vitreous Body

Candida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture.. A 63-year-old patient, diagnosed Fuch's endothelial dystrophy in both eyes underwent a penetrating keratoplasty in his right eye. He had multiple underlying medical problems, which included diabetes mellitus, hypertension, hypoadrenalism on oral dexamethasone and fatty liver secondary to hypertrigliseridemia. He developed multiple suture abscesses, corneal haziness, retrocorneal white plaques and a level of hypopyon two weeks after an uneventful penetrating keratoplasty in his right eye. Cultures of the donor button and the transport media culture were negative. Candida glabrata was isolated successfully from the aqueous and vitreous taps. He was treated with a combination of topical, intracameral, intravitreal and intravenous Amphotericin B. His final visual acuity remained poor due to the haziness of the corneal button.. Candida glabrata endophthalmitis following penetrating keratoplasty can occur in negative donor rim and transport media cultures. The growth of the organism is facilitated by the patient's immunocompromised status. Awareness by the ophthalmologists and appropriate choice of antibiotics are mandatory in this challenging condition.

Topics: Abscess; Administration, Topical; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Drug Administration Schedule; Endophthalmitis; Eye Diseases; Fuchs' Endothelial Dystrophy; Humans; Injections, Intraocular; Injections, Intravenous; Keratoplasty, Penetrating; Male; Middle Aged; Sutures; Transplants; Ultrasonography; Vitreous Body

We report a series of 4 patients who experienced a low-grade mycotic endophthalmitis 3 to 7 months after uneventful cataract surgery. In all patients, the capsular bag was irrigated several times and amphotericin B was instilled intraocularly as well as systemically. In the fourth patient, a pars plans vitrectomy was been performed. Microbiological examination of aqueous humor samples revealed Candida parapsilosis in 3 patients and Candida albicans in 1 patient as causative microorganisms. At follow-up examinations performed up to 12 months after the lavage, visual acuities were 0.2, 0.1, 0.1, and hand motion in the 4 patients, respectively. The main reason for the remaining reduction in visual acuity was retinal and optic nerve atrophy. The findings show that a mycotic etiology of postoperative low-grade infectious endophthalmitis should be considered.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cataract Extraction; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Humans; Middle Aged; Postoperative Complications; Visual Acuity; Vitrectomy; Vitreous Body

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

Acute and invasive fungal infections are usually seen in immunocompromised and debilitated patients. We report a young immunocompetent 28-year-old Indian male who presented with unilateral endogenous endophthalmitis in the left eye and was managed with pars plana vitreous surgery. The polymerase chain reaction from the vitrectomy specimen tested positive for the fungal genome while the cytology examination identified aseptate hyphae with wide-angle branching, most likely suggesting Zygomycosis. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received intravenous dextrose infusions while undergoing a surgical procedure for post-traumatic hydrocele elsewhere a week prior to this episode. The patient was successfully managed with pars plana vitreous surgery along with intravitreal Amphotericin-B and oral Voriconazole.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Fluorescein Angiography; Fundus Oculi; Humans; Immunocompetence; Injections; Male; Pyrimidines; Treatment Outcome; Triazoles; Vision Disorders; Vitrectomy; Vitreous Body; Voriconazole; Zygomycosis

This is a case study of Fusarium keratitis progressing to endophthatmitis that was successfully treated with a tiposomal formulation of amphotericin B (AmBisome] and local natamycin 5%.. A 41-year-old man presented with a clinical picture of endophthalmitis following deep Fusarium solani keratitis. Treatment with natamycin 5% drops and intravenous amphotericin B 150 mg per day caused renal failure and did not alleviate the endophthalmitis. Therefore, intravenous amphotericin B was replaced with intravenous AmBisome, 300 mg per day, to a cumulative dosage of 5.4 g.. Both the endophthalmitis and keratitis were alleviated within several weeks after starting AmBisome treatment. No systemic toxicity was noted. The final ophthalmoLogic examination showed a paracentral corneal scar, and a satisfactory best corrected visual acuity of 20/40.. Due to their relatively low systemic toxicity, liposomal formulations of amphotericin B can be administered in higher doses than traditional unencapsulated ntravenous amphotericin B achieving higher concentrations in the target organ.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Fusarium; Humans; Injections, Intravenous; Keratitis; Male; Mycoses; Natamycin; Visual Acuity

Candidemia in the pediatric burn population poses a management dilemma due to the paucity of good clinical data to guide treatment decisions. Whilst candidemia is less common than bacteremia in pediatric burns patients, it is associated with significant morbidity and mortality. We report a case of candidemia in an infant with 40% burns with ophthalmic complications secondary to nappy rash. We review the investigation and management of ocular candidemia.

Topics: Amphotericin B; Anti-Infective Agents; Candidiasis; Endophthalmitis; Female; Humans; Infant; Review Literature as Topic

In this report, we describe a patient with drug-induced liver failure who developed endogenous endophthalmitis after liver transplantation. Our patient's clinical course was so fulminant that the eye was lost in less than 1 month, without any response to therapy. Recognition of this infection is important because many patients die of disseminated Aspergillus infection, which may be detected early with bedside funduscopic examination by an ophthalmologist. Probably if the patient had referred to us earlier, it may have been possible to save the eye.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus; Ceftazidime; Endophthalmitis; Eye; Humans; Immunosuppression Therapy; Liver Transplantation; Male; Ophthalmologic Surgical Procedures; Ophthalmoscopy; Transplantation, Homologous; Ultrasonography; Vancomycin; Young Adult

This study aimed to report an outbreak of early-onset endophthalmitis caused by Fusarium species following cataract surgery.. The study was designed retrospectively to review microbiologic and medical records of eight cases of endophthalmitis caused by Fusarium species after cataract surgery performed in the same operating room and on the same date by different surgeons at Beyoğlu Eye Training and Research Hospital in Istanbul, Turkey. Seven patients had phacoemulsification and intraocular lens implantation surgery. Intracapsular cataract extraction was performed in one patient. The common feature of these surgeries was the use of intracameral injections of cefuroxime (1 mg in 0.1-ml balanced salt solution-BSS) solutions, which were preoperatively prepared from the same BSS bottle.. The duration between cataract surgery and the diagnosis of endophthalmitis was four days. Aqueous and vitreous specimens obtained from the patients grew fungus colonies that were identified according to their morphologic features and considered to be Fusarium solani. All patients underwent multiple vitrectomies with silicone oil injections. Patients were given local and systemic antifungal agents (amphotericin B and voriconazole). One patient with corneal involvement underwent evisceration despite a variety of treatments. One patient with unregulated diabetes was prephthisic without recurrence of infection. The final visual acuity of patients was between light perception and 20/100.. Fusarium should be considered in the differential diagnosis of early-onset endophthalmitis after cataract surgery. An aggressive treatment with local and systemic antifungal agents and multiple vitrectomies with silicone oil injection is helpful in the management of postoperative early-onset Fusarium endophthalmitis. In the prevention of such outbreaks, it is important to use solutions prepared differently for each patient.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Disease Outbreaks; Drug Therapy, Combination; Endophthalmitis; Eye Evisceration; Eye Infections, Fungal; Female; Fusarium; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Mycoses; Phacoemulsification; Postoperative Complications; Pyrimidines; Retrospective Studies; Triazoles; Turkey; Visual Acuity; Vitrectomy; Voriconazole

The aim of this study was to evaluate the treatment options of experimental in-vivo Candida endophthalmitis. For inoculation, a 0.1 ml of suspension of Candida albicans was injected into the vitreous of the right eye of each New Zealand rabbit. On the 15th day, the clinical evaluation for the resultant endophthalmitis was noted, and vitreous samples were obtained. On the 21st day, culture positive eyes were divided into four groups in terms of treatment modalities. Group 1 (n = 7) received intravitreal amphotericin B injection, group 2 (n = 8) received both intravitreal dexamethasone and amphotericin B injections, group 3 (n = 8) underwent pars plana vitrectomy (PPV) and amphotericin B injection, and group 4 (n = 8) underwent PPV and both amphotericin B and silicone oil injections. The vitreous samples obtained from right eyes of the rabbits on the 15th day, were all culture positive for Candida albicans. On the 35th day, the least colony counts (colony forming unit) were present in eyes that received only intravitreal amphotericin B injection in group 1, followed by group 4 that underwent PPV and both amphotericin B and silicone oil injections. In Candida endophthalmitis, intravitreal injection of amphotericin B without steroid appears to be the primary choice of therapy. In cases who fail to respond to this regimen alone, PPV in combination with silicone oil injection may be considered. Benefit-risk ratio should be cautiously interpreted for application of intravitreal steroid injection.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Dexamethasone; Disease Models, Animal; Endophthalmitis; Glucocorticoids; Injections, Intraocular; Male; Rabbits; Risk Assessment; Silicone Oils; Vitrectomy; Vitreous Body

Guidelines were introduced in 2000 at the Bristol Eye Hospital (BEH) for the management of fungal endophthalmitis. A 5-year retrospective audit re-evaluated the guidelines and monitored the management of this rare condition. Clinical effectiveness and management costs were considered in light of visual outcome.. Cases were identified through a 5-year retrospective review of theatre logbooks, Patient Administration System coded admissions with primary diagnosis of purulent endophthalmitis and pharmacy logbooks of patients receiving antifungal therapy. Data correlation and review of patient management were carried out in light of the findings.. Twenty-three cases were included, based on clinical disease and/or positive smears or cultures. Age range was 13-74 years, with a male : female ratio of 16 : 7 and right eye : left eye ratio of 14 : 9. Risk factors for fungal endophthalmitis included septicaemia caused by intravenous drug use (78%), presence of indwelling lines (9%), postocular surgery (9%) and post-trauma (4%). Guidelines were rigidly followed in 56% of cases, with improved visual acuity in 9/13 patients compared to 4/10 where management deviated from guidelines. Deviation from guidelines occurred with incomplete use of the recommended drug regimen for the disease severity or use of drugs that were alternative to the suggested guidelines. Treatment was initiated on clinical judgement in 91% of cases and laboratory diagnosis in 9%.. The BEH guidelines provided a useful reference when managing this uncommon condition. Voriconazole, a newer broad-spectrum agent with good ocular penetration (used in 9%), has been added to the revised guidelines. Monitoring rare conditions over prolonged time frames supports evidence-based medicine

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Drug Costs; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Flucytosine; Guideline Adherence; Health Care Costs; Humans; Male; Medical Audit; Middle Aged; Mycoses; Practice Guidelines as Topic; Pyrimidines; Retrospective Studies; Treatment Outcome; Triazoles; Visual Acuity; Voriconazole

To study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.. This is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.. Two patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillus sp. and Fusarium sp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 microg/ml for all organisms except for Paecilomyces lilacinus and Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.. Fungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatus was found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Eye Injuries, Penetrating; Female; Humans; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Prospective Studies

We report the first case of endogenous aspergillus endophthalmitis in an immunocompetent person with systemic aortic root aspergillus endocarditis.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Endocarditis; Endophthalmitis; Humans; Male

To evaluate the efficacy of newly developed antifungal agents caspofungin and voriconazole in Candida albicans endophthalmitis in rabbit eyes.. Thirty New Zealand white rabbits were divided into four treatment groups and one control group. One eye of each rabbit was infected by inoculation of 1 x 10(4) CFU/ml of C. albicans. Seventy-two hours after the inoculation, caspofungin 100 microg/0.1 ml in group 1 (n = 6), voriconazole 50 microg/0.1 ml in group 2 (n = 6), amphotericin B 10 microg/0.1 ml in group 3 (n = 6), itraconazole 10 microg/0.1 ml in group 4 (n = 6), and 0.1 ml NaCl 0.9% in control group (n = 6) were injected into the vitreous cavity. Clinical and histopathologic examination scores and microbiological analysis of vitreous aspirates were compared.. There was statistically significant difference in the clinical scores, histopathologic scores, and mean CFU/ml between the treatment and control groups (p < 0.05). In caspofungin and voriconazole groups, histopathologic scores and mean CFU were lower than other treatment groups and control group.. Intravitreal injection of caspofungin and voriconazole was effective against C. albicans endophthalmitis in this experimental rabbit model.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Colony Count, Microbial; Cornea; Disease Models, Animal; Echinocandins; Endophthalmitis; Eye Infections, Fungal; Itraconazole; Lipopeptides; Peptides, Cyclic; Pyrimidines; Rabbits; Triazoles; Voriconazole

To evaluate the efficacy of intracameral amphotericin B injection in the adjunctive management of keratomycosis with probable intraocular extension not responding to conventional antifungal therapy.. Fourteen eyes of 12 patients with fungal keratitis that did not respond to initial treatment with topical and intravenous fluconazole and oral itraconazole were treated with up to 5 intracameral injections of 5 microg of amphotericin B. Six eyes received one injection, and 8 required subsequent injections.. Twelve eyes responded to amphotericin B therapy, including 5 that healed with a central corneal scar and 8 that healed with a peripheral opacity. Two eyes progressed to evisceration. Four eyes developed anterior subcapsular cataract after intracameral amphotericin B.. Intracameral amphotericin B may be an effective adjunctive treatment of fungal keratitis unresponsive to conventional antifungal therapy, although cataract may occur.

Topics: Adult; Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Aspergillus; Candida albicans; Corneal Ulcer; Endophthalmitis; Eye Infections, Fungal; Female; Fusarium; Humans; Injections; Male; Middle Aged; Mycoses; Recurrence; Retreatment; Treatment Outcome

We describe 2 patients with hematologic malignancy who developed endophthalmitis due to Trichosporon beigelii during the course of treatment with multiagent chemotherapy. Blood cultures revealed T beigelii for both patients. Although one of the patients was treated with fluconazole (FLCZ) and 5-fluorocytosine, the trichosporonous endophthalmitis was resistant to both drugs. This patient subsequently received amphotericin B (AMPH-B) therapy, and the eyes were treated with vitrectomy. The second patient also received AMPH-B for FLCZ-resistant trichosporonous chorioretinitis. In both patients, systemic treatment with AMPH-B successfully resolved the trichosporonous endophthalmitis that was resistant to multiple antifungal drugs. Endophthalmitis due to trichosporonosis is difficult to treat. The administration of AMPH-B is likely to be more effective in treating endophthalmitis due to trichosporonosis when the disease is at an early stage.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Drug Resistance, Fungal; Endophthalmitis; Female; Fluconazole; Flucytosine; Humans; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Trichosporon

Endophthalmitis is the inflammatory response to invasion of the eye with bacteria or fungi. The incidence of endophthalmitis after cataract surgery varies between 0.072-0.13 percent. Treatment of endophthalmitis with fungal etiology is difficult.. Case 1: A 71-year old male diabetic patient developed postoperative endophthalmitis due to Aspergillus flavus. The patient was treated with topical amphotericin B ophthalmic solution, intravenous (IV) liposomal amphotericin-B and caspofungin following vitrectomy. Case 2: A 72-year old male cachectic patient developed postoperative endophthalmitis due to Scopulariopsis spp. The patient was treated with topical and IV voriconazole and caspofungin.. Aspergillus spp. are responsible of postoperative fungal endophthalmitis. Endophthalmitis caused by Scopulariopsis spp. is a very rare condition. The two cases were successfully treated with local and systemic antifungal therapy.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Aspergillus flavus; Caspofungin; Drug Therapy, Combination; Echinocandins; Endophthalmitis; Humans; Lipopeptides; Male; Postoperative Complications; Pyrimidines; Treatment Outcome; Triazoles; Vitrectomy; Voriconazole

To observe a new amphotericin B drug delivery system (AmB-DDS), and investigate the therapeutic effects of AmB-DDS on an experimental Aspergillus fumigatus endophthalmitis.. (1) In order to observe the effects of AmB-DDS, thirty-four New Zealand albino rabbits were intravitreal injected Aspergillus fumigatus suspension (10(3) colony forming unit, CFU) in applanation of vitreous body before therapy 48 hours. All models were randomly divided into five groups. Group A was the empty control group, treated nothing after Aspergillus fumigatus injection, group B was the empty DDS implantation combined with vitrectomy, no treatment after DDS implanted, group C: AmB 5 microg-injection combined with vitrectomy, the injection was repeated two week later, group D: 250 microg AmB-DDS intravitreal implantation combined with vitrectomy, Group E: 500 microg AmB-DDS intravitreal implantation combined with vitrectomy. Aqueous flare, cells, anterior vitreous cells and vitreous opacity were graded, and vitreous humor smear and culture were performed at different time points after operation in 8 weeks. Two months after operation, light microscopy was used histology evaluation. (2) To observe the release of AmB-DDS in Group H (6 eyes), 500 microg AmB-DDS were implanted in the eye of the rabbits after vitrectomy, vitreous humor was aspirated and the concentrations of amphotericin B were determined by high performance liquid chromatography (HPLC).. The inflammation response was lower in groups C, D, E than groups A, B. There was no significant statistical difference between group A and group B (P > 0.05), but differences among C, D, E and groups A, B were significant (P < or = 0.005). The inflammation grade was lower in group E than group C (P < or = 0.005). There was significant statistical difference between the cure effect of group E and group D (chi(2) = 10.494, P = 0.003). All of vitreous humor smears was positive in 1.5 months after surgery, but the culture was only positive in group A, and B. Pathological examination indicated that normal structure was disappeared in the eyes with Aspergillus endophthalmitis. At the first day after surgery, AmB were observed by analysis of HPLC, there was sustained AmB release in the group of AmB-DDS application during the observation periods.. The degradable AmB-DDS can effectively suppress the inflammation of the rabbit model of Aspergillus fumigatus endophthalmitis. As an alternative to the current routine therapy, it can be used for the treatment of Aspergillus fumigatus endophthalmitis.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Delivery Systems; Endophthalmitis; Rabbits

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Humans; Immunocompromised Host; Postoperative Complications; Pyrimidines; Recurrence; Triazoles; Voriconazole

To demonstrate the potential value of obtaining routine fungal cultures of donor rims at the time of corneal transplantation and instituting prophylactic therapy in culture-positive cases, even in the absence of clinical evidence of established microbial keratitis or endophthalmitis.. Interventional case report and literature review.. A 69-year-old Saudi man underwent penetrating keratoplasty with donor tissue that was culture-positive for Candida glabrata. The postoperative course was complicated by slight override of the graft associated with an associated epithelial defect, but there was no evidence of microbial keratitis or significant anterior chamber inflammation. Following repair of the graft override on postoperative day 42, the epithelial defect healed. The subsequent clinical course was unremarkable until postoperative day 146, when a deep stromal infiltrate was present at the graft-host junction, associated with a dense endothelial plaque. Cultures of the anterior chamber were positive for Candida glabrata. Treatment with topical and intracameral amphotericin B and systemic fluconazole, along with topical corticosteroids and intracameral t-PA, was successful in eradicating the corneal infiltrate and resolving intraocular inflammation. Four months after treatment was initiated, there was no evidence of recurrent fungal keratitis or endophthalmitis.. This case provides support for the practice of obtaining routine fungal cultures of donor rims at the time of corneal transplantation and for the implementation of prophylactic antifungal therapy in culture-positive cases.

Topics: Aged; Amphotericin B; Anterior Chamber; Candida glabrata; Candidiasis; Cornea; Corneal Ulcer; Disease Transmission, Infectious; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Humans; Keratoplasty, Penetrating; Male; Tissue Donors; Tissue Plasminogen Activator

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Cataract Extraction; Chronic Disease; Combined Modality Therapy; Device Removal; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Itraconazole; Lenses, Intraocular; Mycoses; Postoperative Complications; Vitrectomy

To evaluate the efficacy and toxicity of sustained intravitreal amphotericin B drug delivery system (DDS) on experimental rabbit fungal endophthalmitis of Candida albicans.. Fifty New Zealand rabbits received central vitrectomy were followed by Candida albicans suspension (10(4) colony forming unit, cfu) injection. Rabbits were grouped randomly into five with ten in each as follows: Group A, endophthalmitis control group; Group B, DDS of vehicle alone; Group C, topical treatment with amphotericin B eyedrop; Group D, 5 microg of amphotericin B intravitreal injection every week for two weeks; Group E, DDS contained 1 mg of amphotericin B. Slit-lamp and indirect-ophthalmoscope were performed at different time for two months and vitreous opacity was compared between each group. The intraocular drug concentration was measured with high performance liquid chromatography (HPLC). Light and electron microscope were conducted to evaluate the toxicity of DDS and the effect of vehicle on intraocular structure. Electroretinography (ERG) was employed to evaluate the function of retina before and after the implantation of DDS.. Endophthalmitis was obviously inhibited in group E while vitreous was still opacity in other groups. The drug concentration in vitreous cavity was stable and remained for two months in group E while rapidly went down two weeks later in group D. No toxic evidence was found in ocular, liver and kidney tissue and retinal ultrastructure was normal. There was no difference in ERG study before and after the DDS was implanted.. Sustained intravitreal amphotericin B DDS can significantly suppress the formation of fungal colony and inhibit the development of infection with long and stable intraocular drug concentration maintenance. The vehicle and amphotericin B DDS are safe to intraocular structure.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Drug Delivery Systems; Endophthalmitis; Polyesters; Rabbits; Random Allocation

A fungal infection in the right eye after retina detachment on an immunocompetent patient is reported. After surgery, she developed an infection that was empirically treated with antibiotics and corticoids. Later the patient developed another retina and choroid detachment. The infection evolved to endophthalmitis and a sample was sent to the microbiology laboratory, where Aspergillus fumigatus was isolated. In spite of treatment with intravenous and intravitreous amphotericin B, the eye was eventually removed by enucleation.

Topics: Amblyopia; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Atropine; Combined Modality Therapy; Cryosurgery; Disease Susceptibility; Endophthalmitis; Eye Enucleation; Female; Humans; Immobilization; Laser Therapy; Liposomes; Mydriatics; Myopia; Prednisone; Retinal Detachment; Surgical Wound Infection; Tobramycin; Vitrectomy

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Endophthalmitis; Exophiala; Female; Fungemia; Humans; Itraconazole; Middle Aged; Mycoses; Opportunistic Infections; Osteolysis; Pregnancy; Pregnancy Complications, Infectious; Pyrimidines; Recurrence; Th2 Cells; Triazoles; Voriconazole

To report the efficacy of intravitreal voriconazole.. Retrospective analysis of an interventional case series of five cases of culture-proven fungal endophthalmitis treated with intravitreal voriconazole was done. Only cases found to be resistant to conventional antifungal agents were included in the study. The diagnosis of fungal endophthalmitis was established on the basis of clinical as well as microbiological examination. All patients received one or more intravitreal injections of voriconazole. Resolution was determined on the basis of clinical examination. Resolution of infection and final visual acuity were the main outcome measures.. Resolution of infection was achieved in all five cases. Visual acuity was better in three cases and was maintained in two. Of the three patients who had improvement, two had vision better than or equal to 20/120. Evisceration was avoided in one case with maximal antifungal treatment including voriconazole.. Voriconazole definitely adds to the available treatment options for fungal endophthalmitis. Because of its broad spectrum of activity, it is efficacious in even amphotericin-B- and fluconazole-resistant fungal endophthalmitis.

Topics: Amphotericin B; Antifungal Agents; Drug Resistance, Fungal; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Injections; Male; Middle Aged; Mycoses; Pyrimidines; Retrospective Studies; Triazoles; Visual Acuity; Vitreous Body; Voriconazole

Candida glabrata is a rare cause of endophthalmitis after penetrating keratoplasty. Adequate therapy is still under discussion. With respect to severe complications and side effects of antifungal therapy, a substantial knowledge of sensitivity and resistance of the organism is necessary.. We report on a 26-year-old man with a hyperacute onset of the infection only 10 hours after surgery. A combined therapy for fluconazole and steroids administered over 3 months had shown no effect on intraocular infection.. After topical and intracameral application of amphotericin B in combination with topical prednisolone 3 months after the onset of the endophthalmitis, the infection disappeared within 14 days, and the graft remained clear for 2 months. No toxic effects were noticed.. In the case presented here, topical and intracameral application of amphotericin B was sufficient and safe in the therapy for C. glabrata endophthalmitis after penetrating keratoplasty. Although typically the intraocular infection is first noticed within the first 2 weeks, a hyperacute onset has to be considered.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Glucocorticoids; Humans; Keratoplasty, Penetrating; Male; Postoperative Complications; Prednisolone

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

Endogenous Candida endophthalmitis is a rare disease with increasing frequency and poor prognosis.. The course of endogenous Candida endophthalmitis in 7 eyes of 5 patients (age 2 months to 76 years) was evaluated. Underlying general diseases were diagnosed as colon cancer, diverticulitis, pancreatic insufficiency (with subclavian catheter), ileus and diabetes mellitus. Diagnosis was based on the very typical ocular feature combined with a positive blood or vitreous culture. Intensive antimycotic drug therapy was initiated and pars plana vitrectomy performed as soon as possible.. The delay between onset of ocular symptoms and diagnosis amounted to one week and 2 months. In 3 eyes of 2 patients no vitrectomy could be done because of the very impaired state of health. These patients died of their general diseases one week and 2 months, respectively, later. During follow-up (4 weeks to 51 months) three eyes reached visual acuity of 5/10, 4/10 and 1/10. One eye reached 1/20 after additional surgery because of retinal detachment. In all vitrectomized eyes the diagnosis was substantiated by a positive culture of vitreous fluid. No recurrence of ocular inflammation was observed.. Early vitrectomy seems to be mandatory in each case which is suspected of Candida endophthalmitis. Only with this option it is possible to fix the diagnosis and initiate adequate therapy in due time in order to improve the original poor prognosis.

Topics: Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Candidiasis; Endophthalmitis; Female; Fungemia; Gentamicins; Humans; Infant, Newborn; Infant, Premature, Diseases; Injections; Male; Ophthalmic Solutions; Opportunistic Infections; Prednisone; Risk Factors; Treatment Outcome; Vitrectomy; Vitreous Body

Candida endophthalmitis represents the most serious ocular complication of candidemia. The pharmacokinetics and pharmacodynamics of fluconazole, amphotericin B, and flucytosine are fairly well established in endophthalmitis therapy. There remains a paucity of clinical data regarding the utility of new antimycotic agents in the treatment of fungal chorioretinitis and endophthalmitis. We report a case of clinical failure of caspofungin in the management of Candida albicans endophthalmitis associated with poor vitreous penetration.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Caspofungin; Drug Combinations; Echinocandins; Endophthalmitis; Humans; Lipopeptides; Male; Peptides, Cyclic; Phosphatidylcholines; Phosphatidylglycerols; Treatment Failure

This study was conducted to evaluate the effectiveness of a new antifungal drug, micafungin, and standard antifungal drugs against endophthalmitis induced in a rabbit by intravitreal injection of Aspergillus fumigatus, an important fungal pathogen. Effectiveness was evaluated by the preservation of b-wave amplitude at 72 h after injection of the fungus relative to the b-wave amplitude at baseline before any intravitreal injections. A 0.06 ml inoculum of 10(6) conidia of A. fumigatus was injected into the vitreous of the right eye of all rabbits; and, 12 h later, a 0.06 ml solution containing one of 3 antifungal drugs or saline was injected into the vitreous of both eyes. All three antifungal drugs produced significant b-wave preservation at 72 h in infected eyes compared to that in infected eyes receiving saline injections. There was no statistically significant difference between the effects of micafungin and amphotericin B in the right eyes with fungal endophthalmitis, and both produced significantly more preservation of b-wave amplitude than voriconazole. Amphotericin B, but neither micafungin nor voriconazole produced significant reduction of the b-wave amplitude in the left eyes.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Disease Models, Animal; Echinocandins; Electroretinography; Endophthalmitis; Eye Infections, Fungal; Follow-Up Studies; Lipopeptides; Lipoproteins; Micafungin; Ophthalmoscopy; Peptides, Cyclic; Pyrimidines; Rabbits; Retina; Triazoles; Vitreous Body; Voriconazole

Penetrating keratoplasty carries an infectious risk. Its requirement for topical corticosteroid therapy facilitates fungal growth with resulting keratitis. Although progression of fungal keratitis to intraocular infection is uncommon, endophthalmitis resulting from keratitis usually has a poor visual prognosis. Fungal infection under these circumstances remains a diagnostic and therapeutic challenge. We report a complicated case of recurrent fungal keratitis with endophthalmitis following a contaminated penetrating keratoplasty that ultimately was controlled with a new treatment modality. Intrastromal corneal injections combined with intravitreal injection of amphotericin B led to the eradication of the corneal fungal plaques and the intraocular infection. Intrastromal corneal injections of amphotericin B may offer a less invasive, in-office alternative to repeat penetrating keratoplasty.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Corneal Stroma; Corneal Ulcer; Disease Transmission, Infectious; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Injections; Keratoplasty, Penetrating; Recurrence; Tissue Donors; Vitreous Body

One month after penetrating keratoplasty, a male patient suffered recurrent abscess and endophthalmitis caused by mixed bacteria (Staphylococcus aureus and Candida Albicans).. Two samples of vitreous and aqueous were taken, and a combination of systemic Vancomycin and Amphotericin B were injected intravitreally. The patient was asymptomatic for a month, but the abscess reactivated and was treated with Vancomycin and Ciprofloxacin administered intravenously. Fifteen days after withdrawing the treatment endophthalmitis returned and was treated with vitrectomy and additional systemic/intravitreal antibiotics and antifungal therapy. The final visual acuity was 20/40.. The delayed vitrectomy proved to be necessary to remove established germs and to eliminate recurrent infections.

Topics: Abscess; Adult; Amphotericin B; Aqueous Humor; Candida albicans; Candidiasis; Ciprofloxacin; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Infections, Fungal; Humans; Keratoplasty, Penetrating; Male; Postoperative Complications; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin; Vitreous Body

Topics: Adult; Alternaria; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Immunocompetence; Immunocompromised Host; Mycoses; Vitreous Body

To develop a non-contact and non-invasive method for quantification of the local concentration of certain antibiotic and antifungal drugs in the eye.. An integrated CCD-based Raman spectroscopic system designed specifically for ophthalmic applications was used to non-invasively detect the presence of ceftazidime and amphotericin B in ocular media. Specific Raman signatures of the above named drugs were determined for various concentrations that were injected through a needle in the aqueous humor of rabbit eyes in vivo. Raman spectra were subsequently acquired by focusing an argon laser beam within the anterior chamber of the eye.. Compared to ocular tissue, unique spectral features of ceftazidime appeared near 1,028, 1,506, 1,586, and 1,641 cm(-1). Amphotericin B exhibited its characteristic peaks at 1,156.5 and 1,556 cm(-1). The amplitude of the spectral peak corresponding to these drugs (acquired by 1 second exposure time and 25 mW of laser power) were determined to be linearly dependent on their local concentration in the anterior chamber of the eye.. Raman spectroscopy may offer an effective tool to non-invasively assess the local concentration of the delivered drugs within the ocular media. This technique potentially could be used to investigate the pharmacokinetics of intraocular drugs in vivo either from a releasing implant or a direct injection.

Topics: Amphotericin B; Animals; Anterior Chamber; Anti-Bacterial Agents; Antifungal Agents; Ceftazidime; Drug Monitoring; Endophthalmitis; Rabbits; Spectrum Analysis, Raman

Topics: Amphotericin B; Antifungal Agents; Cataract Extraction; Drug Resistance, Fungal; Endophthalmitis; Eye Infections, Fungal; Humans; Lens Implantation, Intraocular; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Postoperative Complications; Trichosporon; Vitrectomy; Vitreous Body

A case of optic disk neovascularization is reported in a 30-year-old female heroin addict with suspected fungal endophthalmitis treated with an intravitreal injection of amphotericin B and fluconazole (200mg/day). Membrane healing was characterized by densification and contraction leading to tractional retinal detachment; excision by vitrectomy was required. Electron microscopy analysis of the membrane removed the tenth month revealed a poorly vascularized fibrous tissue infiltrated by chronic inflammatory cells. Visual improvement was poor owing to a postoperative macular disorder and a full-thickness retinal scar.

Topics: Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Injections; Neovascularization, Pathologic; Optic Disk; Retinal Detachment; Vitrectomy

The authors present a case of fungal endophthalmitis in the immunosuppressed patient after renal transplantation. The treatment comprised pars plana vitrectomy with silicone oil tamponade, peribulbar injections of Fungizone and intravenous Diflucan. Diagnostic and therapeutic difficulties in endogenous endophthalmitis are discussed.

Topics: Amphotericin B; Antifungal Agents; Endophthalmitis; Fluconazole; Fusarium; Humans; Kidney Transplantation; Mycoses; Postoperative Complications; Vitrectomy

Topics: Amphotericin B; Cornea; Corneal Injuries; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Injuries, Penetrating; Fluconazole; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Ofloxacin; Stenotrophomonas maltophilia; Visual Acuity

To report a case of presumed endogenous bilateral Candida endophthalmitis that developed in an infant with bilateral posterior stage 3 retinopathy of prematurity.. Interventional case report.. In a very low birth weight and extremely premature infant, presumed endogenous bilateral Candida endophthalmitis was successfully eradicated from each eye and retinopathy of prematurity was managed.. Candida endophthalmitis was successfully eradicated from each eye by vitrectomy with instillation of 5 microg amphotericin B. Stage 3 retinopathy of prematurity without "plus disease" in the right eye regressed without ablation of the avascular peripheral retina. Stage 3 retinopathy with "plus disease" in the left eye was successfully managed with endolaser photocoagulation.. Concomitant Candida endophthalmitis and posterior stage 3 retinopathy of prematurity often portend a dismal prognosis. We describe an infant for whom prompt diagnosis and aggressive therapy of both conditions resulted in a favorable anatomic outcome in both eyes.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Endophthalmitis; Fundus Oculi; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Retinopathy of Prematurity; Treatment Outcome; Vitrectomy

We report a 65-year-old diabetic woman who developed Aspergillus niger endophthalmitis after cataract surgery. She presented 9 weeks after extracapsular cataract extraction with a black growth covering the cornea and moderate echoes in the vitreous on ultrasonography. After microbiological confirmation of fungal endophthalmitis, the patient received intravitreal amphoterecin B 5 micro g, topical natamycin 5% hourly, atropine 1% 3 times, and oral antifungal therapy. The patient was told the visual prognosis and was advised to have penetrating keratoplasty and vitrectomy, which she refused.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Atropine; Cataract Extraction; Cornea; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Itraconazole; Natamycin; Vitreous Body

In this report, we review the case of a candidal lens abscess in a premature infant girl who was 28 weeks' gestational age at birth. The culture obtained from the lens abscess grew Candida albicans sensitive to amphotericin B but resistant to flucytosine. This case is unique in that the infant developed a fungal lens cataract at 34 weeks' postconceptional age during the last week of a 30-day course of amphotericin B. The embryonic hyaloid artery system, which perfuses the developing lens, regresses between 29 and 32 weeks of gestation; thus, the mechanism for an infection of the lens may be inoculation of the lens by Candida before hyaloid artery system regression, followed by developmental loss of this blood supply, which makes the lens inaccessible to antimicrobial penetration. Candidal endophthalmitis with lens abscess is an uncommon morbidity that requires prompt recognition and surgical intervention for effective management.

Topics: Abscess; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cataract Extraction; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Lens Diseases; Lens, Crystalline; Ophthalmic Artery

Endogenous Candida endophthalmitis (ECE) is a rare disease. We present a patient with Candida endophthalmitis after two consecutive procedures of suction dilatation and curettage for elective abortion. A 24-year-old single woman who received a suction dilatation and curettage one week ago developed pain and blurred vision in the right eye. Endogenous Candida endophthalmitis was diagnosed and treated with oral fluconazole and pars plana vitrectomy with adjunction of intravitreal amphotericin B injection. The vitreous culture revealed Candida albicans. The vitreous inflammation subsided greatly after the initial treatment but flared up after the second dilatation and curettage for incomplete abortion 5 days after the vitrectomy. The oral fluconazole was replaced by intravenous amphotericin B, and a second vitrectomy with injection of intravitreal amphotericin B was performed. Postoperatively, the intraocular inflammation resolved gradually. Six months after the second vitrectomy, the best-corrected visual acuity in the right eye was 20/25. The excellent visual acuity of this patient was attributed to the early diagnosis and aggressive treatment. For patients with mild disease, less toxic oral fluconazole as the systemic antifungal agent instead of more toxic intravenous amphotericin B has been recommended. For those with advanced disease, intravitreal amphotericin B in conjunction with vitrectomy has been advocated by many eye surgeons.

Topics: Adult; Amphotericin B; Candidiasis; Dilatation and Curettage; Endophthalmitis; Female; Humans; Visual Acuity

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Fluorescein Angiography; Fundus Oculi; Humans; Male; Splenectomy; Tattooing; Vitreous Body

Fungal endophthalmitis: management and therapy (a 9 years experience).. The development of new azoles with a better ocular bioavailability (fluconazole), and the improvement of vitrectomy has recently influenced the treatment of fungal endophthalmitis.. Records of patients treated for fungal endophthalmitis at the Jules Gonin Eye Hospital were retrospectively reviewed from January 1992 to December 2000. Initial and final visual acuities, risk factors, treatment outcomes and side effects were evaluated. Data were examined separately according to the therapy.. 17 patients (13 males, 4 females, mean age 54 years - 27 eyes) were enrolled. 14/27 eyes were treated by oral fluconazole only (group I) for a mean duration of 5.8 +/- 3.4 months. In this series the mean initial visual acuity was 0.73 +/- 0.4 (Snellen chart), the mean final visual acuity was 0.91 +/- 0.3 in 12 eyes, hand motion and light perception in 2 eyes. 10/27 eyes (group II) with severe vitritis and/or retinal detachment underwent pars plana vitrectomy, intraocular injection of amphotericin B, and short course of oral fluconazole. The initial mean visual acuity was 0.36 +/- 0.3 in 8 eyes, hand motion in 2 eyes; the final mean visual acuity was 0.46 +/- 0.4 in 9 eyes. Vitrectomy was repeated in 3 eyes, 1 of which was subsequently enucleated due to painful phthisis. 2 patients (3 eyes) did not receive any treatment.. Oral fluconazol is successful in the management of mild fungal endophthalimitis. In more severe cases, additional vitrectomy and intraocular amphotericin B injection should be considered. In such cases, pars plana vitrectomy is thought to be effective in removing the majority of the fungal charge and in allowing a direct supply of antifungal agents to the retinal infectious foci.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye; Female; Fluconazole; Follow-Up Studies; Humans; Injections; Male; Middle Aged; Retreatment; Retrospective Studies; Vitrectomy

Endogenous Candida endophthalmitis resulting from candidemia in low-birth-weight infants usually occurs as a retinochoroiditis, which is effectively treated with systemic antifungal agents. We report a case of Candida endophthalmitis that recurred 4 months after completion of systemic antifungal therapy. The recurrent Candida infection affected primarily the iris and lens, rather than the retina and choroid. Vitrectomy was required for diagnosis and treatment.

Topics: Amphotericin B; Betaxolol; Candida albicans; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluorouracil; Humans; Infant, Newborn; Infant, Premature; Lens, Crystalline; Microbial Sensitivity Tests; Prednisolone; Recurrence; Vitrectomy; Vitreous Body

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Female; Fluconazole; Humans; Immunosuppression Therapy; Kidney Transplantation; Visual Acuity

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Drug Resistance, Microbial; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Keratoplasty, Penetrating; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Mycoses; Paecilomyces; Treatment Outcome; Visual Acuity

Fluconazole was reported to be an effective alternative to Amphotericin B for candidal endophthalmitis. However, the dose for systemic use had not been determined and few pathological reports on its use have been published. An epiretinal membrane harvested from a regressed candidal endophthalmitis in a patient treated with fluconazole (200 mg/day) was sent for pathologic study. On the inner side of the retina, a granuloma was found. Fungal debris was found within the center of the granuloma, but an intact fungus was seen next to the granuloma. Pathologic study showed incomplete treatment in this case, although systemic status had improved. The use of systemic fluconazole should be maintained for a longer period of time to treat candidal endophthalmitis.

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Female; Fluconazole; Granuloma; Humans; Middle Aged

To determine the clinical presentation, microbiological spectrum, and outcome in cases of fungal endophthalmitis following cataract surgery.. Observational case series.. Tertiary referral hospital.. Retrospective analysis of 27 cases of smear- and culture-proven fungal endophthalmitis.. Pars plana vitrectomy in 18 eyes, where the corneal condition did not preclude the same. All eyes received intravitreal amphotericin B and dexamethasone along with systemic antifungal agents.. Functional success: Final visual acuity of 3/60 or better with attached retina. Anatomical success: Final visual acuity of better than light perception with preserved anatomy of globe.. The majority of the eyes (22 of the 27) had early onset and diffuse presentation (that is, anterior segment as well as posterior vitreous exudates). Substantial corneal involvement was seen in 14 eyes (51.85%). Aspergillus sp. was the most common isolate. Multivariate analysis using forward stepwise logistic regression showed corneal involvement as the single most important risk factor in determining final visual outcome (P =.0429).. Early onset and diffuse presentation, which mimics bacterial endophthalmitis, stresses the importance of both bacterial and fungal cultures from intraocular fluids to reach a diagnosis apart from the clinical judgment. Corneal involvement was the most important predictor of outcome in cases of fungal endophthalmitis.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Cataract Extraction; Dexamethasone; Endophthalmitis; Eye Infections, Fungal; Female; Fungi; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Female; Fluconazole; Fungemia; Humans; Leukemia, Myeloid; Male; Middle Aged; Mycetoma; Neutropenia; Scedosporium

Analysis of the development and treatment of bilateral Candida endophthalmitis after induced abortion in a healthy 31-year-old patient.. A diagnosis of bilateral Candida endophthalmitis was established on the basis of positive vaginal culture, serological finding, and culture for Candida hyphae from the vitreous aspirate. The treatment of the disease consisted of prolonged systemic therapy with amphotericin B and fluconazole and pars plana vitrectomy with intravitreal amphotericin B injection.. After the combined systemic therapy with antibiotics, fungistatics, and corticosteroids proved to be insufficient, pars plana vitrectomy with intravitreal instillation of amphotericin B was performed, which led to the improvement of visual function. After surgery, visual function was maintained with prolonged systemic therapy with fluconazole and methylprednisolone.. Complicated induced abortion may cause bilateral Candida endophthalmitis in a young healthy woman. Elimination of the cause of fungemia and adequate systemic treatment did not cure bilateral endophthalmitis. Pars plana vitrectomy with intravitreal instillation of 5-microg amphotericin B proved as a method of choice in treating this severe ophthalmic disease.

Topics: Abortion, Induced; Adult; Amphotericin B; Antifungal Agents; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Pregnancy; Visual Acuity; Vitrectomy; Vitreous Body

A case of a 31-year-old man with systemic Penicillium marneffei infection acquired in Thailand and who developed endophthalmitis is described. This presentation has not previously been reported. He responded to combined treatment with intravenous and intravitreal amphotericin.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Endophthalmitis; Humans; Male; Penicillium

We report a case of endogenous aspergillus endophthalmitis. This infection occurred in a young immunocompromised boy of 6 years old. The localisation of the chorioretinitis was unusual because out of the posterior area. The evolution was favorable with recovering of the visual acuity under general treatment and intravitreous injections.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Child; Chorioretinitis; Diagnosis, Differential; Endophthalmitis; Humans; Injections; Male; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Vitreous Body

We report a case of Candida (Torulopsis) glabrata endophthalmitis which occurred 2 months following urological surgery. The patient was treated successfully with intravenous amphotericin B lipid complex (ABLC) and flucytosine. Diagnosis and management of this condition are discussed.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Drug Combinations; Endophthalmitis; Humans; Male; Middle Aged; Phosphatidylcholines; Phosphatidylglycerols; Treatment Outcome

To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection.. A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and Acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin B were necessary to eradicate the fungal infection.. Visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK.. The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.

Topics: Acremonium; Aged; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Foreign Bodies; Eye Infections, Fungal; Eye Injuries, Penetrating; Humans; Keratitis; Keratoplasty, Penetrating; Male; Secondary Prevention; Visual Acuity

The authors report the first case of Fusarium solani keratitis that progressed to fungal endophthalmitis and was successfully treated with amphotericin B lipid complex (ABLC).. The case of a 34-year-old immunocompetent woman who developed a contact lens-related F. solani keratitis requiring emergency penetrating keratoplasty (PKP) was analyzed. The immunocompetent patient developed fungal endophthalmitis (anterior chamber tap positive for F. solani three months after PKP) and was eventually treated with ABLC.. Systemic amphotericin B (total, 0.42 g) and ketoconazole in addition to topical natamycin and amphotericin did not prove to be effective in eradicating the mycosis in the anterior chamber. Under ABLC treatment (total, 8.79 g), the anterior chamber inflammation resolved completely. No recurrence was observed during an 11-month follow-up after treatment was discontinued.. ABLC proved to be effective in treating F. solani endophthalmitis. It is an important addition to the ophthalmic armamentarium, and appeared to be a better therapeutic agent than standard amphotericin B in this patient.

Topics: Adult; Amphotericin B; Anterior Chamber; Antifungal Agents; Drug Combinations; Endophthalmitis; Eye Infections, Fungal; Female; Fusarium; Humans; Keratitis; Mycoses; Ophthalmic Solutions; Phosphatidylcholines; Phosphatidylglycerols; Visual Acuity

Topics: Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Cornea; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Graft Rejection; Humans; Iris; Keratitis; Keratoplasty, Penetrating; Recurrence; Reoperation; Saccharomyces; Vitrectomy; Vitreous Body

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Drug Combinations; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Infusions, Intravenous; Phosphatidylcholines; Phosphatidylglycerols

To report two cases of late endophthalmitis caused by Exophiala jeanselmei after cataract surgery.. Case reports, including clinical evaluation, direct examination, and culture of the aqueous humor.. In each case, samples from the anterior chamber had positive growth of yeasts with toruloid hyphae and pseudohyphae. Intravitreal and anterior chamber amphotericin B were used in both cases. Apparent clinical resolution was achieved, but after 3 months in one case and 6 months in the other the infection recurred more aggressively, with severe endophthalmitis leading to ocular atrophy.. E. jeanselmei causes a severe intraocular infection and isolation, and identification of the agent ensures proper diagnosis and treatment. After clinical resolution of the infection, careful and long-term follow-up is recommended to promptly detect relapse and immediately reintroduce treatment.

Topics: Aged; Amphotericin B; Anterior Chamber; Antifungal Agents; Atrophy; Cataract Extraction; Endophthalmitis; Exophiala; Eye; Female; Humans; Middle Aged; Mycoses; Postoperative Complications; Recurrence

We compared the efficacies of fluconazole (Flu), amphotericin B (AmB), and 5-fluorocytosine (5FC) monotherapies with the combination of Flu plus 5FC and Flu plus AmB in a rabbit model of Candida albicans endocarditis, endophthalmitis, and pyelonephritis. The dose of Flu used was that which resulted in an area under the concentration-time curve in rabbits equivalent to that seen in humans who receive Flu at 1,600 mg/day, the highest dose not associated with central nervous system toxicity in humans. Quantitative cultures of heart valve vegetations, the choroid-retina, vitreous humor, and kidney were conducted after 1, 5, 14, and 21 days of therapy. All untreated controls died within 6 days of infection; animals treated with 5FC monotherapy all died within 18 days. In contrast, 93% of animals in the other treatment groups appeared well and survived until they were sacrificed. At day 5, the relative decreases in CFU per gram in the vitreous humor were greater in groups that received Flu alone and in combination with 5FC or AmB than in groups receiving AmB or 5FC monotherapies (P < 0. 005) but were similar thereafter. In the choroid-retina, 5FC was the least-active drug. However, there were no differences in choroidal fungal densities between the other treatment groups. On days 5 and 14 of therapy, fungal densities in kidneys of AmB recipients were lower than those resulting from the other therapies (P < 0.001 and P < or = 0.038, respectively) and AmB-plus-Flu therapy was antagonistic; however, all therapies for fungal pyelonephritis were similar by treatment day 21. While fungal counts in cardiac valves of Flu recipients were similar to those of controls on day 5 of therapy and did not change from days 1 to 21, AmB therapy significantly decreased valvular CFUs versus Flu at days 5, 14, and 21 (P < 0.005 at each time point). 5FC plus Flu demonstrated enhanced killing in cardiac vegetations compared with Flu or 5FC as monotherapies (P < 0. 03). Similarly, the combination of AmB and Flu was more active than Flu in reducing the fungal density in cardiac vegetations (P < 0.03). However, as in the kidney, AmB plus Flu demonstrated antagonism versus AmB monotherapy in the treatment of C. albicans endocarditis (P < 0.05, P = 0.036, and P < 0.008 on days 5, 14, and 21, respectively).

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Creatinine; Endocarditis; Endophthalmitis; Fluconazole; Flucytosine; Kidney; Male; Microbial Sensitivity Tests; Myocardium; Pyelonephritis; Rabbits; Survival Analysis; Time Factors; Vitreous Body

This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis.. The study design was a multicenter retrospective chart review.. Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied.. Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed.. Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured.. All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated.. Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Asthma; Endophthalmitis; Eye Infections, Fungal; Female; Fundus Oculi; Humans; Injections; Lung Diseases, Obstructive; Male; Middle Aged; Retrospective Studies; Substance Abuse, Intravenous; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

This study aimed to present two patients with delayed-onset, endogenous fungal keratitis after treatment for fungal endophthalmitis after cataract surgery.. The authors retrospectively reviewed the clinical course of two patients in whom deep stromal fungal keratitis developed 2 weeks and 3 months, respectively, after apparent successful aggressive therapy for fungal endophthalmitis. Before the onset of the keratitis, both patients underwent vitrectomies with intraocular injection of 7.5 to 10.0 mcg amphotericin B, as well as treatment with systemic fluconazole and topical antifungal therapy. In case 1, a pre-existing prosthetic intraocular lens and lens capsular bag were removed at the time of vitrectomy, whereas in case 2, the intraocular lens was left in place and a posterior capsulectomy was performed.. The keratitis worsened in both patients, despite intensive systemic and topical antifungal therapy. Both patients underwent therapeutic penetrating keratoplasties. In case 1, this resulted in successful resolution of the infection and no recurrences 3 months after the transplant. The corneal transplant was complicated by an expulsive choroidal hemorrhage in the other patient. Fusarium solani was cultured from the initial vitrectomy specimen in patient 1, and although it was not cultured from the keratitis, septate hyphal elements were present on histopathologic examination. The causative organism in case 2 was Acremonium kiliense, which was cultured from both the original vitrectomy specimen and the deep corneal stromal infiltrate.. Fungal organisms may not be eradicated completely from eyes with endophthalmitis despite aggressive therapy and apparent initial successful treatment. These patients need to be monitored for prolonged periods, and treatment should be reinitiated at the earliest sign of recrudescence of infection.

Topics: Acremonium; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cataract Extraction; Corneal Stroma; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Fusarium; Humans; Keratitis; Keratoplasty, Penetrating; Lenses, Intraocular; Male; Mycoses; Retrospective Studies; Vitrectomy

Occurrence of cryptococcal endophthalmitis is rare and commonly is associated with widespread disseminated diseases. The authors report here a well-documented case of endogenous cryptococcal endophthalmitis without the preceding meningeal infection.. A 45-year-old female with a history of long-term use of systemic corticosteroid and cytotoxic drugs for systemic lupus erythematosus suffered from progressive visual loss in her left eye over 1 month. Large exudative retinal detachment and severe vitreous infiltration were observed.. Histopathologic study of the retinal biopsy specimen established the diagnosis of cryptococcal endophthalmitis. Subsequent positive histopathologic study of the aspiration vitreous smear and epiretinal membrane confirmed the recurrence and persistence of the disease over 4 months after the initial presentation. Systemic amphotericin B-fluconazole and two doses of intravitreous amphotericin B injection eliminated the infection successfully.. The authors report here a well-documented case of cryptococcal endophthalmitis and present the serial clinical and histopathologic pictures. The importance of retinal biopsy in diagnosis and the combined form of antifungal treatment also are shown.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Fluorescein Angiography; Humans; Middle Aged; Retina; Vitreous Body

To report two young healthy women who developed endogenous Candida endophthalmitis after undergoing surgically induced abortion.. Case reports.. In two eyes of two patients, a diagnosis of Candida endophthalmitis was established by typical fundus appearance, positive vaginal culture, and, in one case, positive vitreous culture. After vitrectomy and intravitreal amphotericin B injection, one eye of one patient had a best-corrected visual acuity of 20/200, whereas one eye of one patient, who had systemic corticosteroid treatment before the correct diagnosis, developed recurrent retinal detachment and a best-corrected visual acuity of counting fingers.. Induced abortion may cause endogenous Candida endophthalmitis in young healthy pregnant women. Systemic corticosteroid treatment may increase the risk of endophthalmitis.. Reported, in this article, are the cases of two young women who developed endogenous Candida endophthalmitis after induced abortion. Both women experienced transient fever, chills, and abdominal pain after the abortion and were given antibiotics. The diagnosis of endophthalmitis was established on the basis of typical fundus appearance, positive vaginal culture, and (in one case) positive vitreous culture. In the first woman, who received vitrectomy and intravitreal amphotericin B injection, the affected eye had a best corrected visual acuity of 20/200. In the second woman, who was given systemic corticosteroid treatment before the correct diagnosis was reached, recurrent retinal detachment developed and the best corrected visual acuity was counting fingers. It appears that Candida organisms harbored in the genital tract are directly inoculated into the venous system during induced abortion. Once in the blood, if sufficient fungal load is present, Candida albicans tends to localize in the choroid and to spread toward the retina and vitreous cavity. The immunosuppressive effect of corticosteroids further increases the risk of endophthalmitis.

Topics: Abortion, Induced; Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Fundus Oculi; Humans; Pregnancy; Recurrence; Retinal Detachment; Vagina; Vaginal Smears; Visual Acuity; Vitrectomy; Vitreous Body

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis; Catheters, Indwelling; Endophthalmitis; Follow-Up Studies; Humans; Male; Prosthesis-Related Infections; Visual Acuity; Vitrectomy

We report two cases of candidal chorioretinitis occurring to two friends who abused of intravenous crack using the same syringe . An endophthalmitis "a minima" due to a therapeutic delay arose in one patient, when a rare spontaneous healing happened to the second patient. In both cases, an epiretinal membrane is noted after the lesions scarred. Ocular candidal infection is a typical complication occurring to intravenous drug addicts. The visual prognosis depends not only on early diagnosis and treatment, but also on a strict follow-up because late complications are frequent in spite of the healing of initial lesions.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Chorioretinitis; Cocaine-Related Disorders; Crack Cocaine; Endophthalmitis; Epiretinal Membrane; Eye Infections, Fungal; Flucytosine; Humans; Male; Needle Sharing; Substance Abuse, Intravenous

Endogenous endophthtalmitis is an intraocular infection of hematogenous origin.. It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection.. Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Flucytosine; Humans; Male; Middle Aged; Ofloxacin; Oxacillin; Rifampin; Staphylococcal Infections; Vitrectomy

The management of Candida albicans endophthalmitis in intravenous drug abusers (IVDAs) has yet to be established. Early vitrectomy was previously reported as a promising treatment for C. albicans endophthalmitis. In our series, C. albicans endophthalmitis was diagnosed for 15 IVDAs. Funduscopic examinations confirmed severe vitritis in 12 patients and chorioretinitis in three. Blood and vitreal cultures were positive for C. albicans for seven and eight patients, respectively. Patients with vitritis received antifungal therapy before and after vitrectomy. Amphotericin B or fluconazole therapy was given according to the physician's preference. Vitrectomy was defined as early if it was performed within 1 week after the diagnosis of vitritis. All seven patients who underwent early vitrectomy had a favorable response without complications. Two of three patients who underwent late vitrectomy developed blindness or scotoma. Blindness was also described in two patients with vitritis who did not undergo vitrectomy. Early vitrectomy preceded and followed by antifungal therapy seems to be appropriate management of vitritis in IVDAs.

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Heroin Dependence; Humans; Injections, Intravenous; Male; Visual Acuity; Vitrectomy

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Humans; Vitrectomy

We describe a patient with bilateral, delayed endophthalmitis who underwent bilateral pars plana vitrectomy, total capsulectomy, intraocular lens exchange, intravitreal injection of amphotericin B, and oral fluconazole therapy. The long-term inflammation resolved, and vitreous cultures from both eyes yielded Candida parapsilosis. Histopathologic examination revealed sequestered yeast forms in the capsular bags.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Humans; Injections; Lens Capsule, Crystalline; Lenses, Intraocular; Male; Phacoemulsification; Visual Acuity; Vitrectomy

In the past, evidence of endogenous fungal endophthalmitis has been used as a guide to initiating potentially toxic antifungal therapy in patients with systemic fungal infections. Recently, however, a trend has developed to provide patients with antifungal therapy at the first evidence of fungal infection. The authors' study evaluates the incidence of endogenous fungal endophthalmitis in this setting.. The design is a retrospective review of the medical records of patients examined by the inpatient ophthalmology consultation service to rule out endogenous fungal endophthalmitis between January 1994 and April 1996 at the University of Michigan Hospitals, Ann Arbor, Michigan.. Two hundred fourteen eyes of 107 patients with a diagnosis of systemic fungal infection were studied.. A review of medical records was performed.. The findings of the ocular examination, the presence of risk factors for disseminated fungal infection, the type of antifungal therapy, and the source and identity of the isolated fungus were recorded.. The majority of patients examined had either fungal growth from blood cultures or evidence of deep tissue fungal infection. All patients in the study were at risk for fungal disease with each having at least one risk factor for disseminated fungal infection. Of the patients examined, 93.4% already were receiving systemic antifungal therapy at the time of ophthalmologic consultation. Only 3 (2.8%) of the 107 patients examined had chorioretinal findings consistent with early endogenous fungal endophthalmitis. None had intravitreous involvement, and the ocular findings did not change the course of therapy.. Early systemic treatment of deep tissue fungal infection appears to dramatically decrease the incidence of endogenous fungal endophthalmitis.

Topics: Administration, Oral; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Flucytosine; Fungemia; Humans; Incidence; Infant; Injections, Intravenous; Male; Middle Aged; Retrospective Studies

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Endophthalmitis; Eye Infections, Fungal; Glaucoma, Open-Angle; Humans; Itraconazole; Lens Capsule, Crystalline; Male; Ophthalmic Solutions; Phacoemulsification; Trabeculectomy; Visual Acuity

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Chorioretinitis; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Fundus Oculi; Humans; Job Syndrome; Vitreous Body

Four patients presented after cataract surgery with delayed-onset endophthalmitis caused by Acremonium kiliense with in vitro sensitivity to amphotericin B. In all patients, ocular infection was recalcitrant to single-dose intravitreous amphotericin B injection. The authors reviewed the management of endophthalmitis caused by A. kiliense and presented treatment recommendations.. The authors retrospectively evaluated a cluster of four patients with delayed-onset postoperative endophthalmitis after phacoemulsification with posterior chamber intraocular lens implantation. All patients underwent vitreous sampling, intravitreous injection of amphotericin B, and systemic administration of fluconazole. Pars plana vitrectomy was performed in all patients for management of either primary (1 eye) or persistent infection (3 eyes). Two patients with persistent infection also underwent surgical explanation of their posterior chamber intraocular lens.. Worsening infection developed in three of three eyes that underwent vitreous aspiration with intravitreous injection 5 micrograms amphotericin B. These patients subsequently responded to vitrectomy followed by additional intravitreous amphotericin B injection. One eye underwent primary vitrectomy and intravitreous injection of 7.5 micrograms amphotericin B. Although treatment of the initial infection was successful, fungal keratitis developed in this patient 3 months after presentation. Visual outcome was variable, ranging from visual acuity of 20/25 to no light perception with follow-up of 2 years. Epidemiologic investigation suggested a common environmental source for the A. kiliense organisms.. Single-dose administration of intravitreous amphotericin B was inadequate treatment for fungal endophthalmitis caused by A. kiliense. Vitrectomy with repeated intravitreous administration of amphotericin B may be necessary to eradicate intraocular function caused by this organism.

Topics: Acremonium; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aqueous Humor; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Injections; Keratitis; Lenses, Intraocular; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Phacoemulsification; Postoperative Complications; Retrospective Studies; Visual Acuity; Vitrectomy; Vitreous Body

We studied a case in which a patient had unilateral retinal infiltrates and a retinal vasculopathy resembling frosted branch angiitis. He later admitted to injecting cocaine intravenously.. The patient underwent a pars plana vitrectomy and received intravitreal and intravenous amphotericin B.. The vitreous fluid grew Fusarium dimerium. There was rapid response to the treatment and full recovery of vision.. Fusarium species should be considered as a potential pathogen in intravenous drug abusers with endogenous endophthalmitis and in patients with unilateral frosted branch angiitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Cocaine; Endophthalmitis; Eye Infections, Fungal; Fluorescein Angiography; Fundus Oculi; Fusarium; Humans; Male; Mycoses; Substance Abuse, Intravenous; Vasculitis; Vitrectomy; Vitreous Body

A 51-year-old man with acquired immunodeficiency syndrome and cytomegalovirus retinitis had bilateral endogenous fungal endophthalmitis. Cultures yielded Fusarium species. Histopathologic examination showed a severe necrotizing acute and granulomatous reaction, with numerous fungal elements in the retina and uveal tract. Fungal elements were seen in the lens, sclera, and emissarial vessels. Angiopathic infiltration by fungus and widespread thrombosis produced retinal and choroidal infarction. In some areas, fungal infection coexisted with cytomegalovirus retinitis. The bilateral distribution suggests hematogenous seeding of the eyes. The eye findings were the first clinically apparent manifestations of fungal disease in this patient.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cytomegalovirus Retinitis; Endophthalmitis; Eye; Eye Infections, Fungal; Fluconazole; Fungemia; Fusarium; Humans; Male; Middle Aged; Mycoses

We studied a case of Aspergillus endophthalmitis after sutureless cataract surgery.. A patient underwent sutureless phacoemulsification complicated by a posterior capsular tear. She subsequently developed Aspergillus endophthalmitis. Amphotericin B was injected intravitreally at the time of repeat pars plana vitrectomy.. The eye was enucleated because of pain and poor response to treatment.. We recommend suturing the wound in any eye that has experienced a complication of surgery.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Female; Humans; Itraconazole; Lenses, Intraocular; Phacoemulsification; Reoperation; Suture Techniques; Vitrectomy; Vitreous Body

We examined an 82-year-old woman with delayed-onset endophthalmitis caused by an opportunistic pathogen, Ovadendron sulphureo-ochraceum.. Tissue obtained during vitrectomy was cultured and examined by light and electron microscopy. An enucleation specimen was examined by light microscopy.. The patient had fungal endophthalmitis, with O. sulphureo-ochraceum present in the lens capsule. The eye developed a necrotizing scleritis secondary to O. sulphureo-ochraceum. The patient failed to respond to intravitreous, subconjunctival, and systemic amphotericin B, and the eye was enucleated.. In this case of O. sulphureo-ochraceum as a human pathogen, the organism caused endophthalmitis after cataract extraction.

Topics: Aged; Aged, 80 and over; Amphotericin B; Cataract Extraction; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Female; Humans; Lens Capsule, Crystalline; Lenses, Intraocular; Mitosporic Fungi; Mycoses; Vitrectomy; Vitreous Body

Candida endophthalmitis may occur either during systemic Candida infection (candidemia), particularly in immunocompromised hosts or as a single manifestation in drug abusers.. One case of endogenous candida endophthalmitis (ECE) in a patient with systemic candidiasis and four cases of drug abusers are presented. Well confined inflammatory lesions in retina and choroid were adequately treated with systemic Amphotericin B administration, whereas lesion extension beyond the internal limiting membrane towards the vitreous required surgical management, to remove epiretinal fibrovascular tissue, and intravitreal Amphotericin B injection.. In all cases, treatment resulted to regression of the lesions, however visual function recovery depends on location of chorioretinal lesions.

Topics: Adult; Amphotericin B; Candidiasis; Chorioretinitis; Combined Modality Therapy; Dose-Response Relationship, Drug; Endophthalmitis; Female; Humans; Injections, Intravenous; Male; Middle Aged; Opportunistic Infections; Vitrectomy

From January 1991 to March 1993, a total of 11 infants with positive blood, urine, cerebrospinal fluid (CSF) or stool cultures of Candida albicans were found in the nursery or neonatal intensive care unit of the Chung Shan Medical and Dental College Hospital. Clinical features including respiratory deterioration, poor activity, abdominal distension and/or apnea were noted. Indwelling peripheral venous catheters had been used in all patients to provide parenteral nutrition and broad spectrum antibiotic therapy and six infants had received intravenous fat emulsions. Prolonged endotracheal intubation with mechanical ventilation had been used in eight infants. Six infants (54.5%) had meningitis, five infants (45.5%) had endophthalmitis, and two infants (18.2%) had arthritis. All 11 infants received intravenous amphotericin B therapy, and the concurrent oral administration of 5-fluorocytosine was used in the six infants with meningitis. Three infants died later. Since meningitis was recognized in 54.5% patients and endophthalmitis was recognized in 45.5% patients with systemic candidiasis, the author recommends that culture and analysis of CSF along with indirect ophthalmoscopy should be performed on all infants suspected of having systemic candidiasis.

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Flucytosine; Humans; Infant; Infant, Newborn; Meningitis, Fungal; Prognosis

Candida is becoming an important nosocomial pathogen as the incidence of hospital-acquired candidemia is rising. Candida endophthalmitis is a good indicator of systemic candidiasis in hospitalized patients.. Thirteen (17%) of 76 ophthalmologic consultations for Candida endophthalmitis in our institution had positive findings during a 12-month period. We studied these 13 patients with Candida endophthalmitis to evaluate their outcomes.. All 13 patients were admitted to a large tertiary care hospital, and 10 (77%) were in an intensive care unit. The overall mortality was 77% for all patients and 80% for the intensive care patients. This mortality was higher than the overall mortality for all patients in the surgical intensive care unit in our institution (17%), as well as the mortality for our patients with candidemia in the surgical intensive care unit (61%).. The strikingly high mortality in our group of patients with Candida endophthalmitis reflects the fact that they are a seriously ill group with multiple risk factors for Candida infection. This information suggests that the presence of Candida endophthalmitis is a good indicator of high mortality in seriously ill patients in intensive care units.

Topics: Adult; Aged; Amphotericin B; Candidiasis; Endophthalmitis; Fluconazole; Hospital Mortality; Humans; Middle Aged; Retrospective Studies; Treatment Outcome

Postoperative fungal endophthalmitis typically manifests as an indolent uveitis, weeks to months after surgery. In our patient, Torulopsis magnoliae endophthalmitis appeared as an acute, purulent postoperative endophthalmitis on the third day following extracapsular cataract extraction with implantation of a posterior chamber intraocular lens (IOL). The patient required three separate vitrectomy operations with instillation of intravitreal Amphotericin B; the last operation also included complete removal of the posterior capsule and IOL. This case, which is to our knowledge the first reported case of T. magnoliae endophthalmitis, is unusual in that it manifested as an acute, fulminant infection in the early postoperative period and was recalcitrant to standard endophthalmitis therapy.

Topics: Acute Disease; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Cataract Extraction; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Lenses, Intraocular

Topics: Aged; Amphotericin B; Candidiasis; Cataract Extraction; Chronic Disease; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Humans; Vitreous Body

We present an unusual case of Aspergillus fumigatus endogenous endophthalmitis in a 27 year old Hispanic male with no history of ocular trauma, surgery, hematologic malignancy, compromised immune system, or intravenous drug use. The patient presented with a two-day history of pain, redness, and visual acuity of bare count fingers in his right eye. He was originally suspected of having toxoplasmic retinochoroiditis, but clinically worsened on systemic anti-toxoplasma medication and corticosteroids. He subsequently underwent pars plana vitrectomy and treatment with intravenous and intravitreal amphotericin B. Aspergillus fumigatus was isolated and identified in the vitreous aspirate. With aggressive medical and surgical management, he eventually regained visual acuity of 20/30 in his right eye. This case illustrates the occurrence of endogenous Aspergillus endophthalmitis in a patient with no history of intravenous drug use, ocular trauma, or compromised immune system, and successful outcome with combined medical and surgical management.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Endophthalmitis; Eye Infections, Fungal; Fundus Oculi; Humans; Immunocompetence; Male; Visual Acuity

Congenital candida infection is a rare disease, although the incidence of candida vaginitis during pregnancy is high. We report on five cases each showing patterns considered typical for candida infection. The infective agent can cause chorioamnionitis even in the presence of intact fetal membranes. An intrauterine device (IUD) has been proved to be a risk factor for a congenital candida infection. The pathogenetic significance of contamination with candida for the fetus appears to depend largely on gestational age. A premature infant with a birth-weight less than 1500 g presented with bilateral candida endophthalmitis which was cured by intravenous Fluconazole therapy. Another premature infant weighing 800 g at birth developed a systemic candida infection. The other three more mature infants had milder symptoms, two of them presented with cutaneous candidiasis.

Topics: Adult; Amniocentesis; Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Chorioamnionitis; Drug Therapy, Combination; Endophthalmitis; Female; Fetal Membranes, Premature Rupture; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nystatin; Pregnancy

The incidence of candidemia and its complications, such as endophthalmitis, has measurably increased in recent years. However, the optimal method of treatment of hematogenous candidal infection remains a controversial issue. Traditional therapy with amphotericin B is associated with well-known adverse reactions. Many clinicians therefore prefer to use fluconazole, which is administered orally and is relatively less toxic. We recently observed a patient with candidal sepsis in whom blinding endophthalmitis developed despite aggressive and lengthy therapy with fluconazole. This grave clinical outcome and the data derived from experimental models of ocular candidal infection suggest that empirical usage of fluconazole may not be warranted in cases of disseminated candidiasis potentially complicated by endophthalmitis.

Topics: Adult; Amphotericin B; Candidiasis; Cross Infection; Endophthalmitis; Female; Fluconazole; Fungemia; Humans; Pyelonephritis

We report this exemplary case of a drug addict with candida endophthalmitis where we used the new form of amphotericin B, encapsulated in liposomes. We were able to reconfirm the reduced number of side effects and the minimized nephrotoxicity reported by authors of other specialties. In our patient, a reduction or elimination of the yeast was probably achieved, nevertheless, he developed a traction retinal detachment. In future cases of fungal endophthalmitis, we recommend liposomal amphotericin B in higher doses.

Topics: Adult; Amphotericin B; Candidiasis; Dose-Response Relationship, Drug; Drug Carriers; Endophthalmitis; Fluorescein Angiography; Humans; Infusions, Intravenous; Liposomes; Male; Opioid-Related Disorders; Retina; Substance Abuse, Intravenous; Vitreous Body

A 32-year-old man had unilateral visual loss, a gravitational layering of preretinal inflammatory cells in the macula (pseudohypopyon), subretinal infiltrates, and hemorrhagic vasculitis. The patient initially denied intravenous drug abuse. Apsergillus terreus was cultured from undiluted vitreous obtained from a diagnostic and therapeutic vitrectomy specimen. Intravitreal and subconjunctival injections of amphotericin B alone were successful treatment. To the author's knowledge, antemortem diagnosis and treatment of A. terreus-induced endophthalmitis has not been reported previously. This article describes the second case of aspergillar endophthalmitis successfully treated without adjunctive systemic antifungal therapy.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Endophthalmitis; Eye Infections, Fungal; Humans; Male; Vitreous Body

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Fluconazole; Follow-Up Studies; Humans; Male; Middle Aged; Vitrectomy

Candida krusei has become an increasingly important invasive pathogen, particularly in immunocompromised patients. Previous experimental and clinical experience suggest that C. krusei has a low propensity for hematogenously infecting the eye. We report 10 cases of fungemia due to C. krusei at our institutions, including three cases of endophthalmitis due to C. krusei. Fungemia was associated with nodular skin lesions in all seven patients with neutropenia and occurred despite administration of antifungal prophylaxis or empirical therapy. None of the patients apparently died as a direct result of C. krusei fungemia. Treatment with amphotericin B resulted in resolution of endophthalmitis, although one patient required vitrectomy. Early institution of aggressive therapy with amphotericin B may alter the course and improve the prognosis of C. krusei infection, particularly in immunocompromised patients.

Topics: Aged; Amphotericin B; Candida; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Fungemia; Humans; Male; Middle Aged; Prospective Studies; Retrospective Studies; Skin

Topics: Amphotericin B; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Humans; Mycetoma; Pseudallescheria; Vancomycin

A rabbit model of exogenous Candida albicans endophthalmitis was used to determine if intravitreal corticosteroids combined with an efficacious antifungal agent enhanced fungal proliferation and ocular destruction, or if the combination can suppress the inflammatory and immunogenic response that causes retinal and uveal destruction. Exogenous Candida albicans endophthalmitis was experimentally induced in 20 rabbit eyes. Eight eyes received intravitreal amphotericin B alone; eight eyes received amphotericin B plus dexamethasone. Four eyes served as controls. By clinical grading on the fourth day after infection, the vitreous of the eyes in the two drug-treated groups was significantly clearer in comparison to that of eyes in the control group. By the seventh day after infection, the eyes treated with amphotericin B plus dexamethasone had significantly clearer vitreous in comparison to the eyes receiving only amphotericin B (P = 0.0017). Quantitative culture results were negative in both treatment groups, and histopathologic examination confirmed the clinical grading. Contrary to current beliefs, there was no evidence that the addition of corticosteroids impaired antifungal activity or enhanced fungal proliferation.

Topics: Amphotericin B; Animals; Candidiasis; Dexamethasone; Disease Models, Animal; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Fungal; Fundus Oculi; Injections; Rabbits; Vitreous Body

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Humans

We report a case of atypical bilateral endogenous mycotic endophthalmitis in an infant. A diagnostic vitrectomy was done on the left eye. Electron microscope examination of the vitreous demonstrated fungal mycelia. Intravenous treatment with amphotericin B seemed effective for treating the infection of the right eye, but a vitrectomy was necessary to prevent deprivation amblyopia and retinal traction, secondary to persistence of a dense vitreous membrane.

Topics: Amphotericin B; Candida albicans; Endophthalmitis; Female; Humans; Infant; Infant, Newborn; Staphylococcus; Vitrectomy; Vitreous Body

Topics: Aged; Alternaria; Amphotericin B; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Humans; Lenses, Intraocular; Retinal Detachment; Visual Acuity; Vitrectomy; Vitreous Body

We compared the efficacy of intravenous fluconazole (80 mg/kg of body weight per day) with that of amphotericin B (1 mg/kg/day) for the long-term treatment of endophthalmitis in rabbits with disseminated candidiasis. After 17 days of therapy, fluconazole decreased the fungal colony counts of the choroid-retinas significantly more than did the saline control (P less than 0.05); however, after 24 days of fluconazole therapy, this treatment effect was lost and fluconazole was no more effective than saline. In contrast, treatment for 24 days with amphotericin B reduced the vitreous and choroid-retina fungal colony counts significantly more than either fluconazole or saline (P less than 0.05 for both treatment groups). After 17 days of therapy, indirect ophthalmoscopy revealed less severe eye involvement in both antifungal treatment groups than in saline controls; however, this difference reached statistical significance only for the amphotericin B-treated rabbits (P less than 0.05). Also, there was a trend towards worsening eye lesions, as seen by indirect ophthalmoscopy, in the fluconazole-treated rabbits after 24 days of therapy, which roughly paralleled the quantitative culture results. Despite the presence of negative choroid-retina cultures, some rabbits in all treatment groups had persistently visible eye lesions, indicating that ophthalmoscopic resolution of Candida endophthalmitis may lag behind lesion sterilization. Amphotericin B was superior to fluconazole in the treatment of Candida endophthalmitis in this model.

Topics: Amphotericin B; Animals; Candida albicans; Candidiasis; Endophthalmitis; Female; Fluconazole; Kidney; Rabbits

Fusarium pathogen is an uncommon cause of infections in ophthalmology. To our knowledge, there are few cases of isolated human endogenous endophthalmitis without concomitant immunodepression. An early diagnostics and therapy allowed an excellent functional recovery when compared to the reported cases in the literature.

Topics: Adult; Amphotericin B; Endophthalmitis; Female; Flucytosine; Fusarium; Humans; Mycoses; Vitrectomy

Eight consecutive cases of culture-proven endogenous Candida endophthalmitis (ECE) were managed between 1980 and 1988. All patients were treated with vitrectomy and injection of intravitreal amphotericin B. Blood cultures were negative in all patients, although Candida albicans was cultured from a foot ulcer in one patient. No systemic therapy was used in three patients, three patients received oral ketoconazole, and two patients received oral flucytosine postoperatively. Intravenous amphotericin B was not used because of lack of evidence of disseminated candidiasis and the systemic toxicity associated with its use. The ECE responded favorably to treatment in all cases. Final vision was better in patients with a shorter interval between onset of symptoms and initiation of antifungal therapy. Posttreatment visual acuities were: four eyes greater than or equal to 20/50, two eyes at 20/80 to 20/200, and two eyes less than 5/200. This series showed that ECE without evidence of disseminated disease can be treated successfully with vitrectomy and intravitreal amphotericin B.

Topics: Adult; Aged; Amphotericin B; Candida; Candida albicans; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Humans; Ketoconazole; Male; Middle Aged; Prognosis; Visual Acuity; Vitrectomy; Vitreous Body

The efficacy of intravitreally administered amphotericin B was evaluated. Experimental fungal infections were produced by inoculation of Candida albicans organisms into the vitreous cavities of 46 rabbit eyes. After 72 hr, eight eyes received intravitreal injections of 10 micrograms of free amphotericin B; and ten eyes each received 10 micrograms, 20 micrograms, and 40 micrograms of liposome-bound amphotericin B. The remaining eight eyes served as controls: four eyes received dextrose solution and four eyes received empty liposomes. Histopathologic examination 8 weeks after inoculation showed clear vitreous without retinal damage in groups treated with either 10 micrograms free amphotericin B or 20 micrograms of liposome-bound drug. All eyes in the control group and six eyes (60%) in the group treated with 10 micrograms of liposome-bound amphotericin B developed vitreous abscesses with evidence of fungal infection. In eyes treated with 40 micrograms of liposome-bound amphotericin B, fungal infection was successfully eradicated, but retinal damage was detected in all eyes by light microscopy. It is proposed that a reduced toxicity of intravitreally injected liposome-bound drugs is accompanied by reduced efficacy. In the treatment of fungal endophthalmitis, an increased dosage of liposome-bound amphotericin B (above that dosage of free drug which would be required) is suggested.

Topics: Amphotericin B; Animals; Candidiasis; Drug Carriers; Endophthalmitis; Injections; Liposomes; Rabbits; Retinal Diseases; Time Factors; Vitreous Body

The incidence of systemic mycotic infections, though formerly rare, has increased dramatically over the past two decades. Candida albicans has been recognized as the most common pathogen in endogenous fungal endophthalmitis. Accurate antemortem diagnosis of disseminated candidiasis is made, however, only in a few cases. Ocular findings may often provide the first definitive clue to an underlying mycotic infection. We present four cases of candidal endophthalmitis; in each the ophthalmologist played a major role in the early diagnosis of the underlying systemic infection, allowing specific therapeutic measures to be taken. We also discuss the common predisposing factors, ocular symptoms and findings, clinical course, and response to antifungal therapy.

Topics: Aged; Amphotericin B; Candidiasis; Endophthalmitis; Eye Diseases; Female; Flucytosine; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Retinal Diseases; Uveitis; Visual Acuity; Vitreous Body

Fungal endophthalmitis is an uncommon complication of intraocular surgery. We report, to our knowledge, the first case of a postoperative Zygomycetes endophthalmitis that occurred after uncomplicated phacoemulsification and the insertion of a posterior chamber intraocular lens. Diagnosis, in the presence of negative aqueous and vitreous cultures, was confirmed by immunofluorescence staining of an anterior chamber inflammatory mass. Successful treatment of the eye with 20 micrograms of intraocular amphotericin B (Fungizone) may have been made possible in part by the fact that the posterior capsule remained intact, keeping the eye bicompartmental.

Topics: Amphotericin B; Cataract Extraction; Endophthalmitis; Fungi; Humans; Male; Middle Aged; Mucormycosis; Postoperative Complications

Topics: Adult; Amphotericin B; Endophthalmitis; Humans; Injections; Male; Mycoses; Paecilomyces; Recurrence; Vitreous Body

Endogenous Aspergillus flavus endophthalmitis with layering of inflammatory cells in the subretinal space and vitreous infiltration developed in a 35-year-old female intravenous drug abuser. The patient underwent a diagnostic and therapeutic vitrectomy within 48 hours of presentation, receiving intravitreal amphotericin B. Intravenous amphotericin also was administered several days later. Despite extensive retinal and vitreous involvement, the patient recovered useful vision because of the aggressive diagnostic and therapeutic approach.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Endophthalmitis; Female; Fundus Oculi; Humans; Injections, Intravenous; Retinitis; Substance-Related Disorders; Visual Acuity; Vitrectomy

Inflammatory reactions following cataract extraction and implantation of an intraocular lens are rare complications. In a group of 10,000 patients the incidence of toxic lens syndrome was 0.15%; infections were seen in 0.07% of the cases. Except for two patients with toxic lens syndrome associated with cystoid macular edema, all ultimately had good visual acuity. While toxic lens syndrome is seen in the first postoperative week or recurs at a later date and responds very well to corticosteroids, bacterial endophthalmitis usually develops on the first postoperative day, with fulminant progress. Mycotic infections occur after a longer interval and temporarily respond better to corticosteroids. The endophthalmitis should be treated early with a vitrectomy to eliminate micro-organisms and toxic agents, and to achieve a high intraocular level of antibiotics and antimycotics. From June 1982 to June 1987, thirteen patients with endophthalmitis after cataract extraction were vitrectomized. Navigating visual acuity was ultimately achieved in eight cases. Two patients developed a phthisis bulbi and one a recurrent mycosis. Thus, altogether, an inflammation-free eye with navigating visual acuity can be achieved in over 50% of cases.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Combined Modality Therapy; Dexamethasone; Diagnosis, Differential; Endophthalmitis; Gentamicins; Humans; Hydrocortisone; Lenses, Intraocular; Middle Aged; Postoperative Complications; Vitrectomy

Topics: Amphotericin B; Ascomycota; Drug Resistance, Microbial; Endophthalmitis; Humans; Immune Tolerance; Ketoconazole; Kidney Transplantation; Male; Middle Aged; Mycoses; Pseudallescheria

Topics: Administration, Oral; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Cataract Extraction; Drug Contamination; Endophthalmitis; Humans; Ketoconazole; Male; Surgical Wound Infection; Therapeutic Irrigation

Twenty-two isolates from patients with postsurgical endophthalmitis due to infection with Candida parapsilosis as a result of exposure to a contaminated ocular irrigating solution were classified by enzyme profile analysis and antifungal susceptibility. These isolates were identical to a single isolate obtained from a contaminated vial but could be differentiated, on the basis of enzyme profile and antifungal susceptibility, from randomly selected stock isolates. The combination of these tests appears to have value in discriminating epidemic from non-epidemic strains.

Topics: Amphotericin B; Candida; Candidiasis; Disease Outbreaks; Drug Contamination; Endophthalmitis; Flucytosine; Humans; Ketoconazole; Miconazole; Microbial Sensitivity Tests; Postoperative Complications

A general review of the treatment of Candida endophthalmitis is undertaken, with particular emphasis on the efficacy of various drugs currently in use. Their absorption by the eye when given systemically is also considered. The limitations of medical treatment for this condition are discussed and the theoretical reasons for vitrectomy considered. Six cases that underwent vitrectomy are reviewed, and the indications for vitrectomy in Candida endophthalmitis are discussed. A tentative overall plan for the management of such cases is given.

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Female; Flucytosine; Follow-Up Studies; Humans; Ketoconazole; Male; Visual Acuity; Vitrectomy

Topics: Amphotericin B; Cloxacillin; Endophthalmitis; Gentamicins; Humans; Injections; Vitrectomy; Vitreous Body

The presentation and management of 10 cases of proven or presumptive fungal endophthalmitis in narcotic-drug abusers is described. Miconazole was found to be an effective agent in some patients when administered in a dosage of 2400 mg/day. Eight patients received treatment with a combination of miconazole and flucytosine (5-fluorocytosine). Regression of the infection with preservation of the eye was observed in each case. However, visual acuity in the affected eye improved only in four of the eight patients; it was unchanged in two and had deteriorated in the other two. In two patients, who received amphotericin B and flucytosine as initial treatment, control of the infection was achieved, but vision remained unchanged. Vitrectomy was performed in three patients to remove residual sites of infection. However, vision remained unchanged in two of these patients and worsened in the third. The selection of individual modalities of therapy and responses to treatment are discussed.

Topics: Adult; Amphotericin B; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Heroin; Humans; Male; Miconazole; Mycoses; Substance-Related Disorders; Visual Acuity; Vitrectomy

Nine heroin addicts with presumed candidal endophthalmitis were seen in Glasgow between November 1982 and April 1984. Six patients during a two month period in 1983. The physical symptoms and signs observed, results of laboratory investigations and responses to anti-fungal chemotherapy are reported. Epidemiological factors relating to possible sources of infection are explored.

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Disease Outbreaks; Endophthalmitis; Female; Fundus Oculi; Heroin Dependence; Humans; Ketoconazole; Male; Scotland

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Flucytosine; Humans; Ketoconazole

Two series of patients with endophthalmitis were compared. In the group treated with antibiotics or fungistatics, only 1 eye (4.3%) could be salvaged, whereas in the group with pars plana vitrectomy and antibiotics or fungistatics, 7 eyes (33%) had adequate visual acuity afterwards.

Topics: Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Endophthalmitis; Humans; Injections; Mycoses; Oxytetracycline; Visual Acuity; Vitrectomy; Vitreous Body

Ocular clearance of amphotericin B after direct intravitreal injection was studied in a rabbit model. Unmodified phakic eyes, Candida-infected eyes, aphakic eyes, and aphakic vitrectomized eyes were employed. Using high pressure liquid chromatography to assess drug level, the half-lives of drug disappearance after single 10-microgram (microgram) intravitreal injections were 9.1, 8.6, 4.7, and 1.4 days, respectively. The disappearance slope for vitrectomized eyes was significantly different from all nonvitrectomized eyes with P less than 0.001. The rapid disappearance of amphotericin from vitrectomized eyes must be considered in clinical management of patients with fungal endophthalmitis.

Topics: Amphotericin B; Animals; Candidiasis; Endophthalmitis; Half-Life; Kinetics; Rabbits; Reference Values; Vitrectomy

Topics: Adult; Amphotericin B; Endophthalmitis; Eye Injuries; Humans; Male; Mycoses

We describe the first case of successfully treated exogenous aspergillus endophthalmitis following penetrating injury and primary scleral wound repair. After repeated vitreous surgery with multiple intravitreous instillations of amphotericin B combined with intravenous antifungal therapy the patient's visual acuity was 6/18. A vigorous approach in the management of mycotic endophthalmitis is emphasised and the role of closed vitrectomy discussed.

Topics: Adult; Amphotericin B; Aspergillosis; Endophthalmitis; Humans; Male; Sclera; Wound Infection

A 49-year-old man developed Aspergillus endophthalmitis after a perforating corneal injury. The infection was successfully treated with antifungal therapy and surgery.

Topics: Amphotericin B; Aspergillosis; Endophthalmitis; Eye Injuries; Flucytosine; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Candidiasis; Diagnosis, Differential; Endophthalmitis; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Toxoplasmosis, Ocular

A 51-year-old man who was being treated with corticosteroids for chronic extrinsic asthma developed biliary tract sepsis, candidemia, and Candida endophthalmitis with vitreous fluff-ball lesions in both eyes. Extensive vitreous fibrosis and retinal detachment with loss of useful vision occurred in his left eye, which had a vitreous biopsy. Useful vision was maintained in his right eye with two full courses of systemic amphotericin B, 5-flucytosine, and a cataract extraction. Encapsulated Candida organisms remained in the vitreous of his right eye at the time of death. Useful vision can be preserved without aggressive vitreous surgery and intravitreal anti-fungal agents in eyes with intravitreal Candida albicans.

Topics: Amphotericin B; Candidiasis; Cataract Extraction; Endophthalmitis; Eye Infections, Fungal; Fibrosis; Flucytosine; Fungemia; Humans; Male; Middle Aged

Endophthalmia due to Candida has increased in incidence over the last few years, particularly in drug addicts. Two cases of severe bilateral Candida albicans endophthalmia are reported. Histological examination of the globes following treatment by amphotericin B i.v. and secondary vitrectomy demonstrated persistence of Candida, particularly in the preretinal membrane, in the first case. Treatment in the second case consisted of amphotericin B i.v. and 5 fluorocytosine, associated with vitrectomy and an intravitreal injection of 5 micrograms of amphotericin B. Fungal elements were absent on histological examination of the globes. Ocular Candida albicans lesions may be of exogenous origin but contamination arises more frequently from an endogenous source. The resulting endophthalmia leads to retinal nodules having a tendency to extend into the vitreous. Clinical features are fairly typical and diagnosis not a problem. General treatment consists of combined administration of amphotericin B and 5 fluorocytosine, but results are often disappointing as effective penetration of these compounds into the intraocular zone is not obtained. Early vitrectomy, when a vitreal lesion exists, offers many advantages such as the possibility to identify Candida in the removed aqueous humor. As histological examination shows persistence of Candida in the preretinal membrane, the vitrectomy should be combined with intravitreal injections of amphotericin B.

Topics: Aged; Amphotericin B; Candidiasis; Endophthalmitis; Female; Humans; Uveitis; Visual Acuity; Vitreous Body

A 49-year-old outdoor laborer had an endophthalmitis in one eye and small posterior segment lesions in the other, as well as raised lesions on his skin. The diagnosis of disseminated North American blastomycosis was established by the performance of a biopsy on one of the skin lesions. The ocular inflammation slowly improved with intravenous amphotericin B therapy, and the ocular lesions, presumably caused by Blastomyces dermatitidis, were followed clinically for six months. The patient died of a hospital-acquired pneumonia caused by Staphylococcus aureus.

Topics: Amphotericin B; Blastomycosis; Dermatomycoses; Endophthalmitis; Eye Diseases; Humans; Male; Middle Aged

Progressive endogenous Candida albicans endophthalmitis was established in rabbits by intravenous (IV) injection of blastospores (2.0 to 5.0 x 10/kg). Severity of infection was directly related to the strain and inoculum size. Intravenous amphotericin B (1.0 mg/kg/day), IV amphotericin B methyl ester ascorbate (5.0 mg/kg/day), and oral ketoconazole (80 mg/kg/day) effectively prevented or reduced the severity of infection when therapy was initiated 24 hours following inoculation of blastospores and continued for five to seven days. Intravenous miconazole (30 mg/kg/day) was ineffective in this model. Intravenous amphotericin B(1.0 to 2.0 mg/kg on alternate days), IV amphotericin B methyl ester ascorbate (5.0 mg/kg/day), and oral ketoconazole (80 mg/kg/day reduced the severity of C albicans endophthalmitis when therapy was initiated seven days following injection of blastospores and continued for 28 days. Oral flucytosine (75 and 150 mg/kg/day in four doses) produced uniformly fatal hepatic necrosis in uninfected rabbits.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Endophthalmitis; Imidazoles; Injections, Intravenous; Ketoconazole; Male; Piperazines; Rabbits

Antibiotics were administered intravitreally to 26 patients with culture-verified endophthalmitis. Vitrectomy surgery was combined with intravitreal antibiotic therapy in 14 of the cases. Pretreatment selection into a vitrectomy or nonvitrectomy group was determined by the duration of the disease, type of predisposing injury, and echographic findings. This diagnostic-treatment grouping allowed management to be initiated on the basis of the existing and potential virulence of the infecting process. The less virulent and often successfully managed Staphylococcus epidermidis accounted for 67% of cases in the nonvitrectomy group and only 14% in the vitrectomized series. During a mean follow-up period of 32 months (range, one to five years), retinal changes were monitored by visual acuity determination, electroretinography, and fluorescein angiography. An overall visual improvement (greater than or equal to 20/400) was found in 73% of the eyes treated. The causes for failure in the remaining cases may be related to retinal damage from the initiating trauma, organism response, and intraocular antibiotic therapy.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Cephalothin; Child; Dexamethasone; Drug Therapy, Combination; Endophthalmitis; Female; Gentamicins; Humans; Male; Methicillin; Staphylococcal Infections; Vitreous Body

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fundus Oculi; Heroin Dependence; Humans; Male

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Electroretinography; Endophthalmitis; Female; Humans; Visual Acuity; Vitreous Body

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Disease Models, Animal; Drug Therapy, Combination; Endophthalmitis; Fluorescein Angiography; Imidazoles; Injections, Intravenous; Ketoconazole; Miconazole; Microbial Sensitivity Tests; Piperazines; Rabbits; Retinitis; Time Factors

Two infants recovered from endogenous Candida endophthalmitis. Case 1, to the best of my knowledge, is the first reported full term neonate with this entity. Free-floating vitreous opacitis ("ballon vitréen") were found in one infant and the second infant's lesions resolved in a more conventional manner.

Topics: Amphotericin B; Candidiasis; Ductus Arteriosus, Patent; Endophthalmitis; Female; Flucytosine; Humans; Infant; Infant, Newborn; Infant, Premature; Intestinal Obstruction; Intestine, Small; Male; Nystatin; Oxygen

The maximum nontoxic dose of amphotericin B methyl ester in vitrectomy infusion fluid was found to be 75 microgram/ml. Experimentally induced fungal endophthalmitis in rabbits was cured by vitrectomy using infusion fluid that contained 10 microgram/ml of amphotericin B methyl ester.

Topics: Amphotericin B; Animals; Candidiasis; Endophthalmitis; Gentamicins; Infusions, Parenteral; Rabbits; Vitreous Body

Three patients with endogenous fungal endophthalmitis were treated intravenously with miconazole. Two patients had disseminated coccidioidomycosis, and one patient had disseminated candidiasis. Intraocular mycotic infections developed in one patient undergoing therapy, and progressed in two others also undergoing therapy. All three patients' ocular infections improved after therapy was switched to intravenous amphotericin B administration. Previous experience with miconazole and amphotericin B therapy for fungal endophthalmitis is reviewed. Whereas several failures have been noted with amphotericin B and success with miconazole, our experience suggests systemic administration of amphotericin B may be superior to systemic administration of miconazole for intraocular mycoses, although further clinical data are urgently needed.

Topics: Adult; Amphotericin B; Candidiasis; Coccidioidomycosis; Endophthalmitis; Female; Fluorescein Angiography; Fundus Oculi; Humans; Imidazoles; Injections, Intravenous; Male; Miconazole; Middle Aged

Case report on a 59-year-old woman who was affected by a Candida septicaemia after several abdominal interventions. After therapy with amphotericin B and 5-flurocytosine the disappearance of a central retinal metastasis is documented. Beside these drugs, clotrimazole, miconazole, econazole, and some combinations with amphotericin B are more recent possibilities.

Topics: Amphotericin B; Candidiasis; Cytosine; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Humans; Imidazoles; Sepsis

One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.

Topics: Adult; Amphotericin B; Aspergillosis; Endophthalmitis; Female; Flucytosine; Humans; Microbiological Techniques; Substance-Related Disorders; Visual Acuity; Vitreous Body

A 27-year-old man sustained a thorn injury to his left eye and a culture-proven Fusarium oxysporum endophthalmitis developed. This was successfully treated with a vitrectomy, intravitreal and intravenous amphotericin B, and oral flucytosine. The patient maintains 20/20 vision at this time in his left eye. We recommend combined therapy for this filamentous fungal infection.

Topics: Adult; Amphotericin B; Drug Resistance, Microbial; Drug Therapy, Combination; Electroretinography; Endophthalmitis; Flucytosine; Fusarium; Humans; Male; Mycoses; Vitreous Body

Patients with endogenous Candida endophthalmitis associated with intravenous (IV) drug abuse may manifest ocular and systemic signs different from those seen in other forms of endogenous Candida endophthalmitis. There may be a sparcity of evidence of systemic candidiasis, including negative serology and normal physical examination results. Anterior uveitis and extensive vitreous involvement are common and do not necessarily have associated typical retinal lesions, which are more commonly seen in the compromised host. This may occur either because of the more transitory nature of choroidal or retinal lesions or because these patients often seek treatment at later stages. Even with a typical clinical picture, it is difficult to get culture confirmation of the diagnosis. Material obtained by vitrectomy must be concentrated before inoculation of media because of the known difficulty of culturing Candida from the vitreous cavity.

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fundus Oculi; Heroin Dependence; Humans; Male; Middle Aged

Amphotericin B methyl ester, a water-soluble derivative of amphotericin B, is an experimental antifungal agent. Intravitreous injection of 5 and 10 micrograms of amphotericin B methyl ester in the normal rabbit eye does not cause toxic changes that can be detected clinically, microscopically, or by electroretinography. A single intravitreous injection of 5 micrograms was effective in reversing the course of exogenous Candida fungal endophthalmitis when administered within five days after inoculation of the infecting organism.

Topics: Amphotericin B; Animals; Candidiasis; Disease Models, Animal; Endophthalmitis; Injections; Mycoses; Rabbits; Vitreous Body

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida; Candidiasis; Cross Infection; Endophthalmitis; Female; Humans; Male; Middle Aged; Mycoses; Remission, Spontaneous; Risk; Saccharomyces cerevisiae

We diagnosed mycotic endophthalmitis by positive cultures in a 47-year-old man and a 42-year-old woman, both intravenous amphetamine users. Reinfection with a different fungal species was documented in one case. Rapid identification of the isolate, in vitro susceptibilities, selection of appropriate routes and dosages of antifungals, and the role of adjunctive corticosteroids are crucial factors in the management of these difficult cases. We prescribed antifungals and adjunctive corticosteroids, and our patients' vision improved.

Topics: Administration, Oral; Administration, Topical; Adult; Amphetamines; Amphotericin B; Antifungal Agents; Aspergillosis; Candida; Candida albicans; Candidiasis; Clotrimazole; Endophthalmitis; Female; Flucytosine; Humans; Injections, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Prednisolone; Prednisone; Substance-Related Disorders

A severe granulomatous iridocyclitis developed in association with a cavitary pulmonary lesion in a 29-year-old man. The initial diagnosis and treatment was for pulmonary tuberculosis with tuberculous uveitis. Although the pulmonary lesion improved with antituberculous therapy, the condition of the eye deteriorated. An anterior-chamber tap was positive for Coccidioides immitis, and the patient was treated with intravenous and two intracameral injections of amphotericin B. The eye was ultimately enucleated three weeks after the initial intracameral injection, and yet was culture-positive for the organism. Histopathologic examination disclosed diffuse involvement of the anterior segment, with multiple spherules present within the iris and limbus.

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Endophthalmitis; Humans; Lung Diseases, Fungal; Male; Uveitis, Anterior

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Humans; Substance-Related Disorders

Primary sporotrichosis of the eye is very rare; most infections are limited to the conjunctiva or adnexa. We report a case of Sporothrix endophthalmitis associated with necrotizing ethmoid sinusitis developing in a young diabetic man with ketoacidosis. The infection clinically resembled rhino-ophthalmic mycormycosis. Cure followed evisceration and an abbreviated course (215 mg) of amphotericin B. Sporothrix must now be regarded as another fungal agent capable of causing primary rhino-ophthalmic infection similar to Mucor.

Topics: Adult; Amphotericin B; Debridement; Diabetes Complications; Diagnosis, Differential; Endophthalmitis; Humans; Male; Mucormycosis; Sporotrichosis

Topics: Adult; Aged; Amphotericin B; Corneal Transplantation; Cryptococcosis; Endophthalmitis; Female; Flucytosine; Humans; Postoperative Complications; Tissue Donors; Transplantation, Homologous

A 43-year-old heroin addict with Candida albicans endophthalmitis was treated with a single 5-mug intravitreal injection of amphotericin B. The diagnosis was confirmed by smears and cultures of a vitrous aspiration. The patient's accidental death seven weeks after treatment enabled us to obtain histopathologic evidence that the infection had been cured and that the amphotericin B had had no toxic effect on the retina. Intravitral amphotericin B should be considered an important mode of treatment of Candida endophthalmitis.

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fluorescein Angiography; Humans; Male; Phenmetrazine; Substance-Related Disorders; Visual Acuity

Topics: Amphotericin B; Bacterial Infections; Dexamethasone; Endophthalmitis; Gentamicins; Humans; Injections; Mycoses; Vitreous Body

Topics: Aged; Amphotericin B; Atropine; Cataract Extraction; Endophthalmitis; Female; Humans; Mycoses; Postoperative Complications; Pupil

Candida endophthalmitis, caused by transient candidemia, developed in a 14-year-old white girl receiving intravenous hyperalimentation. Antifungal synergism was established in vitro for the combination of amphotericin B and rifampin against the C. albicans isolate. A combined ten-day course of intravenous amphotericin B and oral rifampin was followed by the elimination of the infection and the preservation of good visual acuity.

Topics: Administration, Oral; Adolescent; Amphotericin B; Candida albicans; Candidiasis; Catheterization; Endophthalmitis; Female; Humans; Injections, Intravenous; Rifampin; Visual Acuity

A 27-year-old white man had endogenous Candida endophthalmitis with fungi in the vitreous cavity, presumably caused by hematogenous spread related to drug abuse, and was treated by pars plana vitrectomy and antifungal medications administered systemically after surgery. There was no evidence of other systemic involvement, and excision of fungi from the vitreous cavity confirmed the clinical diagnosis and determined the sensitivity of this fungus to antifungal medications. The fungus was sensitive to flucytosine (5-FC), which the patient received orally since it was less toxic to body tissues than amphotericin B. The intraocular infection cleared rapidly after vitrectomy, and visual acuity returned to 6/5 (20/15).

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Endophthalmitis; Flucytosine; Humans; Male; Microbial Sensitivity Tests; Ophthalmoscopy; Postoperative Care; Substance-Related Disorders; Vitreous Body

The histological examination of five bulbi with exogenous mycotic endophthalmitis reveals invasion of fungi confined to the anterior segment including the anterior vitreous body. Hyphae are found within abscesses, and granulomas respectively. The posterior eye remains relatively free, however a posterior vitreous detachment always exists together with a massive retraction of the vitreous gel. These findings should be kept in mind if intravitreal injections of amphotericin-B, or a vitrectomy are considered. After intravitreal injections of amphotericin-B no retinal lesions could be revealed.

Topics: Aged; Amphotericin B; Endophthalmitis; Female; Humans; Mycoses

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Endocarditis, Bacterial; Endophthalmitis; Fundus Oculi; Humans; Male; Natamycin; Streptococcus

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Flucytosine; Heroin Dependence; Humans; Male

A premature neonate developed advanced bilateral endophthalmitis before the significance of underlying Candida sepsis was appreciated. Severe endophthalmitis resulted in corneal thinning, descemetocele formation, and perforation. The infection occurred in the clinical setting of broad-spectrum antibiotic therapy and indwelling intravenous catheters. Cultures of blood and catheter tips had been positive for Candida but were not considered significant until advanced ocular infection was noted. The septic process resulted in the infant's death after systemic amphotericin B therapy was discontinued because of renal toxicity.

Topics: Amphotericin B; Candidiasis; Corneal Diseases; Endophthalmitis; Eye; Humans; Infant, Newborn; Infant, Premature, Diseases; Klebsiella Infections; Male; Nystatin

A case of Candida endophthalmitis was clinically diagnosed three weeks after perforating injury. It was successfully treated with vitrectomy and intravitreal injection of 5 mcg of amphotericin B. A Candida speices was cultured from the vitreous aspirations.

Topics: Amphotericin B; Candida; Candidiasis; Child; Endophthalmitis; Eye Injuries; Humans; Male; Visual Acuity; Vitreous Body

Topics: Amphotericin B; Antifungal Agents; Arthritis, Infectious; Candidiasis; Cytosine; Drug Resistance, Microbial; Drug Therapy, Combination; Endophthalmitis; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis; Osteomyelitis; Pyelonephritis; Radiography; Recurrence; Sepsis

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Endophthalmitis; Eye; Heroin Dependence; Humans; Inhalation; Male; Pupil; Vitreous Body

Topics: Amphotericin B; Anterior Chamber; Cataract Extraction; Endophthalmitis; Female; Humans; Iris; Middle Aged; Mycoses; Postoperative Complications; Pseudallescheria; Vitreous Body

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Conjunctivitis; Cytosine; Endophthalmitis; Female; Fluorine; Humans; Infant, Newborn; Infant, Premature; Iritis; Male; Middle Aged

Topics: Amphotericin B; Blood; Candida; Candida albicans; Candidiasis; Catheterization; Diverticulitis, Colonic; Endophthalmitis; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Retinitis; Sepsis

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Candida albicans; Candidiasis; Catheterization; Cytosine; Endophthalmitis; Female; Fluorine; Fundus Oculi; Humans; Male; Middle Aged; Sepsis; Uveitis

Topics: Acremonium; Amphotericin B; Aqueous Humor; Blood; Cataract Extraction; Drug Therapy; Endophthalmitis; Eye Diseases; Geriatrics; Humans; Injections, Intravenous; Keratitis; Mycoses; Pharmacology; Postoperative Complications; Uveitis

Topics: Amphotericin B; Candida; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Humans; Nystatin; Ophthalmology; Ophthalmoscopy; Retina; Sepsis; Vitreous Body