amphotericin-b and Retinal-Diseases

Invasive bacterial and candidal infections are known to involve the retina, but the natural history of the retinal lesions and the utility of ophthalmologic consultation in the critical care setting as a diagnostic tool are not well understood. We 1) performed weekly funduscopic examinations on 77 medical and surgical patients in intensive care units (ICUs), 2) analyzed results of serial ocular examinations in 180 non-neutropenic patients with candidemia, and 3) reviewed the English literature on the association of retinal lesions with disseminated bacterial or candidal infection (DBCI). We found that 15 (19%) of the ICU patients had retinal lesions consistent with DBCI. Of these 15, 1 had clearly sepsis-related retinal lesions, while 13 (87%) had 1 or more systemic disease that could have explained their retinal findings (6 diabetic retinopathy; 2 human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) retinopathy; 2 hypertensive retinopathy; 1 hemolytic uremic syndrome, and 1 leukemia). Multivariate analysis revealed that systemic disease (odds ratio 8.37, 95% confidence intervals: 3.24-21.56) independently correlated with the presence of retinal lesions while DBCI, trauma, hyperalimentation, and transfusion of blood products were not independently predictive in any analysis. Twenty of the 180 (15%) candidemic patients had retinal lesions. Two (1%) had classic 3-dimensional white lesions with vitreal extension, and 5 (2.7%) had chorioretinal lesions without vitreal haziness. Notably, 10% of patients had superficial retinal hemorrhages and/or cotton wool spots that could have been due to either candidemia or a systemic disease (diabetes, hypertension, renal failure, closed head trauma). Concurrent bacteremia occurred in 3 of the 27 patients with eye lesions. Retinal lesions resolved in a mean of 33 days. None of the patients had symptoms at the time of the retinal finding. We found 3 studies that prospectively assessed retinal lesions in bacteremic patients. The frequency of retinal lesions in these series varied from 12% to 26%, with the most common lesions being cotton wool spots followed by superficial retinal hemorrhages. White-centered hemorrhages were seen in about 15% +/- 2 of bacteremic patients. Five studies prospectively evaluated candidemic patients for Candida endophthalmitis. These studies observed rates from 0% to 78% for lesions consistent with candidal endophthalmitis. Most studies performed recently found tha

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Corynebacterium Infections; Female; Fluconazole; Humans; Male; Middle Aged; Prospective Studies; Retinal Diseases; Severity of Illness Index; Staphylococcal Infections

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

Topics: Adolescent; Adult; Amphotericin B; Animals; Cataract Extraction; Child; Child, Preschool; Electrocoagulation; Eye Diseases; Eye Foreign Bodies; Female; Hemorrhage; Humans; Infant, Newborn; Male; Methicillin; Methods; Middle Aged; Postoperative Complications; Prostheses and Implants; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Urokinase-Type Plasminogen Activator; Uvea; Vitreous Body

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

A human immunodeficiency virus-negative 63-year-old male with autoimmune hemolytic anemia presented with decreased vision, photophobia and hearing loss. After initial testing seemed consistent with sarcoidosis, he was found to have disseminated Cryptococcus with a cryptococcoma of the left eye. Treatment with systemic anti-fungal therapy improved the patient's condition.

Topics: Amphotericin B; Anemia, Hemolytic, Autoimmune; Antifungal Agents; Cryptococcosis; Cryptococcus; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Flucytosine; HIV Seronegativity; Humans; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Meningitis, Fungal; Middle Aged; Recurrence; Retinal Diseases; Tomography, X-Ray Computed; Vitreous Body

To determine the toxicity of various doses of intravitreal amphotericin B deoxycholate, amphotericin B lipid complex (ABLC), and liposomal amphotericin B (L-AmB).. Fifty-two rabbits were divided into two treatment groups (groups A and B). Thirteen treatments were administered intravitreally to the 104 rabbit eyes. Treatments included a control plus 10, 20, 30, and 50 micro g amphotericin B deoxycholate, ABLC, and L-AmB. Eye examinations were performed before injection and on day 11 for group A and on day 18 for group B. At death, on days 13 and 21 in groups A and B, respectively, vitreous humor was aspirated and concentrations of amphotericin B were determined by high performance liquid chromatography (HPLC), followed by enucleation for histologic studies.. Significantly more eyes treated with ABLC showed development of vitreal opacities than developed in eyes treated with amphotericin B deoxycholate or L-AmB (P < 0.05). Vitreal band formation was significantly higher in ABLC-treated eyes than in those treated with L-AmB, (P = 0.039). Vitreal inflammation was greater in eyes treated with L-AmB (75%), amphotericin B deoxycholate (78%), and ABLC (91%) than with the control (50%; P = 0.08). Retinal ganglion cell loss was greater in eyes treated with amphotericin B deoxycholate (81%), L-AmB (91%), and ABLC (97%) than with the control (38%; P = 0.003). Amphotericin B concentrations were measurable for all doses of the three formulations.. Based on histologic data, increasing doses of all three agents appear to be associated with increasing toxicity, however based on ophthalmologic data, L-AmB appears to be less toxic than either amphotericin B deoxycholate or ABLC.

Topics: Amphotericin B; Animals; Antifungal Agents; Chromatography, High Pressure Liquid; Deoxycholic Acid; Drug Combinations; Eye Diseases; Phosphatidylcholines; Phosphatidylglycerols; Rabbits; Retinal Diseases; Retinal Ganglion Cells; Vitreous Body

To describe an unusual case of disseminated sporotrichosis with intraocular involvement.. Interventional case report.. An 18-year-old man presented with disseminated ulcerated skin lesions. Fundus examination showed fluffy opacities in the vitreous and a retinal granuloma in the left eye. Biopsy of the skin lesion and lymph node showed the presence of numerous fungus cells. Culture was positive for the diagnosis of disseminated sporotrichosis.. Although intraocular infection due to Sporothrix schenckii is uncommon, it can occur in case of disseminated sporotrichosis. Systemic therapy is a successful means to control skin and ocular sporotrichosis.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Biopsy; Eye Diseases; Eye Infections, Fungal; Granuloma; Humans; Male; Retinal Diseases; Skin; Sporothrix; Sporotrichosis; Vitreous Body

Topics: Acute Disease; Adult; Amphotericin B; Ethmoid Sinusitis; Eye Infections, Fungal; Female; Follow-Up Studies; Fundus Oculi; Humans; Mucormycosis; Orbital Diseases; Retinal Diseases

A 62-year-old woman without evidence of immunocompromise was evaluated for uveitis and a subretinal lesion in the right eye. Laboratory evaluation, including cerebrospinal fluid analysis, revealed no apparent cause. The diagnosis of subretinal cryptococcosis was established by transscleral needle biopsy of the subretinal mass. Treatment with intravenous amphotericin B and oral 5-flucytosine brought recovery of visual acuity to 20/30-1 and resolution of the inflammation. This patient demonstrates that ocular cryptococcal infection must be suspected, even in the absence of predisposing factors or systemic findings, and that subretinal fine-needle aspiration is an important diagnostic tool in this setting.

Topics: Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Eye Infections, Fungal; Female; Flucytosine; Fluorescein Angiography; Fundus Oculi; Humans; Immunocompromised Host; Middle Aged; Retinal Diseases; Visual Acuity

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

The retinal toxicity of intravitreally administered amphotericin B was compared in non-vitrectomised versus vitrectomised rabbit eyes. Doses of 5 and 10 micrograms in both groups resulted in transient vitritis but had no effect on electroretinograms. Histopathological examination four weeks after injection showed vitreous cells and minimal areas of retinal necrosis in both groups at 5 or 10 micrograms doses. At these doses vitrectomy did not modify the retinotoxic effects of intravitreally administered amphotericin B. At higher doses marked toxicity was found in both vitrectomised and non-vitrectomised groups.

Topics: Amphotericin B; Animals; Dose-Response Relationship, Drug; Electroretinography; Necrosis; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Vitrectomy; Vitreous Body

The ocular toxicity of liposome-intercalated amphotericin B and commercial amphotericin B were compared after intravitreal injection in healthy pigmented rabbits. Ophthalmoscopic observations over 5 weeks following a single intravitreal injection showed vitreal band formation and focal retinal damage after doses of commercial amphotericin B as low as 5 micrograms. Such lesions were not seen in animals given liposomal amphotericin B in doses up to 20 micrograms. Histopathologic examination showed areas of retinal atrophy or necrosis in five of 16 rabbits given commercial amphotericin B in doses of 5-20 micrograms but in none of 16 rabbits given the same doses of liposomal amphotericin B (P = 0.02). Small white vitreal bodies were seen clinically in virtually all animals given liposomal amphotericin B or "empty" (drug-free) liposomes but in only a few animals given commercial amphotericin B; these deposits may represent residual lipid. Concentrations of amphotericin B ranged from 0.4 to 1.0 micrograms per ml of vitreous humor 5 weeks after injection of 5-20 micrograms of either formulation. These studies indicate that liposome association markedly reduces the ocular toxicity of amphotericin B.

Topics: Amphotericin B; Animals; Injections; Liposomes; Rabbits; Retinal Diseases; Vitreous Body

A 26-year-old woman had an enlarging dense macular lesion in the right eye. The funduscopic and angiographic findings were distinctly different from those in macular histoplasmosis. She was found to have a coccidioidomycotic granuloma in the left lung and was treated with amphotericin B. Within a month the macular lesion was cicatricial. This appears to be the first reported case of presumed ocular coccidioidomycosis in Canada.

Topics: Adult; Amphotericin B; Canada; Coccidioidomycosis; Female; Fluorescein Angiography; Humans; Lung Diseases, Fungal; Macula Lutea; Retinal Diseases

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

Topics: Adult; Amphotericin B; Candidiasis; Colitis, Ulcerative; Cytosine; Female; Fluorescein Angiography; Fundus Oculi; Humans; Retinal Diseases