amphotericin-b and Fuchs--Endothelial-Dystrophy

To evaluate the cost-effectiveness of supplementing hypothermic cold storage media (CSM) with antifungal therapy.. Cost-effectiveness analysis (CEA).. Base case of a patient with Fuch's endothelial dystrophy undergoing a first eye keratoplasty.. Cost-effective analysis of the base case with corneal tissue stored in CSM or CSM supplemented with antifungal therapy over a 16-year time horizon. Multiple clinical scenarios were considered, including endothelial keratoplasty (EK) and penetrating keratoplasty (PK); amphotericin B, voriconazole, caspofungin, and combination therapy; and third-party payer and societal perspectives. The incidences were derived from PubMed literature searches and average wholesale prices of medications; all costs were discounted 3% per annum and adjusted for inflation to 2019 US dollars.. Incremental cost-effectiveness ratios (ICERs).. In the reference case, a corneal endothelial graft stored in amphotericin B-supplemented CSM was the most cost-effective approach from a third-party payer and societal perspective. Probability sensitivity analysis (PSA) of the societal model for the EK was robust, with 93.5% being below an arbitrary willingness-to-pay threshold (WTP) of $20 000 per fungal infection averted. Voriconazole, caspofungin, and combination antifungals were less cost-effective than amphotericin B. The main factors influencing the CEA were the incidences of postkeratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKs, antifungal supplementation was less cost-effective than for EKs.. Antifungal supplementation with amphotericin B for EK grafts was the most cost-effective approach of the studied antifungals; however, the CEA was sensitive to potential changes in graft failure rates, underlining the importance of long-term safety studies. For full-thickness corneal grafts, antifungal supplementation was less cost-effective.

Topics: Aged; Amphotericin B; Antifungal Agents; Caspofungin; Cornea; Cost-Benefit Analysis; Cryopreservation; Descemet Stripping Endothelial Keratoplasty; Drug Combinations; Drug Costs; Eye Infections, Fungal; Fuchs' Endothelial Dystrophy; Health Services Research; Humans; Keratoplasty, Penetrating; Male; Organ Preservation Solutions; Postoperative Complications; Voriconazole

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