Candida endophthalmitis associated with intraocular lens implantation: efficacy of fluconazole therapy

Four patients with Candida parapsilosis endophthalmitis following intraocular lens implantation were treated with oral fluconazole. All had failed prior therapy with intravitreal amphotericin B. The only patient who had the lens implant removed was cured after treatment with fluconazole for one year. Three patients who did not have the lens implant removed had resolution of symptoms and return of visual acuity towards normal during the year they were on fluconazole. However, five months after therapy had been stopped, all three had decreasing visual acuity, and in two, culture of vitreous fluid yielded C. parapsilosis. Fluconazole may be effective for treatment of endophthalmitis associated with an intraocular lens implant, but only when the implant is removed also.