Treatment of endogenous fungal endophthalmitis: focus on new antifungal agents

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Published on: February 6, 2021

James Riddell1, Grant M Comer, Carol A Kauffman

  • 1Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|January 18, 2011
PubMed

Insights

Treating endogenous fungal endophthalmitis requires careful antifungal selection. Voriconazole and intravitreal injections offer promising therapeutic concentrations for sight-threatening infections, especially those caused by Candida species.

Area of Science:

  • Ophthalmology
  • Mycology
  • Infectious Diseases

Background:

  • Endogenous fungal endophthalmitis is a severe ocular infection compromising vision.
  • Commonly associated with candidemia and invasive aspergillosis.
  • Systemic antifungal penetration into the eye is variable, complicating treatment.

Purpose of the Study:

  • To review evidence on optimal antifungal agent use for endogenous fungal endophthalmitis.
  • To emphasize treatment strategies for Candida species infections.
  • To evaluate antifungal concentrations in the posterior segment of the eye.

Main Methods:

  • Review of available scientific evidence.
  • Analysis of pharmacokinetic data for antifungal agents in the vitreous.
  • Focus on clinical efficacy for fungal endophthalmitis.

Main Results:

  • Systemic amphotericin B (AmB) has poor ocular penetration; fluconazole has high concentrations.
  • Voriconazole demonstrates promising therapeutic vitreous concentrations against Candida and Aspergillus.
  • Posaconazole and echinocandins do not achieve adequate vitreous concentrations.

Conclusions:

  • Voriconazole shows potential for treating fungal endophthalmitis due to its broad spectrum and vitreous penetration.
  • Intravitreal AmB or voriconazole injections are crucial for rapid, high-dose local therapy in severe cases.
  • Antifungal selection must consider ocular penetration and specific fungal pathogens, particularly Candida species.

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