Intravitreal voriconazole as primary treatment for endogenous Aspergillus endophthalmitis

This report describes the first case of Aspergillus endophthalmitis after heart transplantation which was successfully treated with intravitreal voriconazole. A 62-year-old man receiving immunosuppressive agents after a heart transplant presented with pain, reduced visual acuity and redness of the left eye. The patient had been diagnosed with invasive pulmonary aspergillosis and was being treated with intravenous voriconazole. Endogenous endophthalmitis was diagnosed. Aspergillus fumigatus was isolated in a vitreous sample. After five intravitreal voriconazole injections (50 μg/0.1 ml), pars plana vitrectomy, intravenous and topical voriconazole treatment, there was no ocular inflammation and the visual acuity improved from counting fingers at 50 cm to 20/20. This case report shows that intravitreal voriconazole, in addition to topical and systemic treatment, was safe and very effective in treating Aspergillus endophthalmitis. More clinical studies are needed to determine the optimal treatment for this condition.