Fungal endophthalmitis in narcotic abusers. Medical and surgical therapy in 10 patients

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.