Successful salvage therapy of Fusarium endophthalmitis secondary to keratitis: an interventional case series

Purpose To describe a combination of treatment modalities used for the successful eradication of Fusarium endophthalmitis. Design Interventional case series. Participants Three consecutive patients with keratitis-associated Fusarium endophthalmitis. Methods After failure of traditional management options, a combination of intravitreal and long-term, high-dose systemic voriconazole, topical antifungal medications, and surgical intervention, with penetrating keratoplasty, lensectomy, and endoscopic-guided pars plana vitrectomy, was administered to each patient. Results All three cases achieved full resolution of the infection, with a final Snellen visual acuity score of 20/50 to 20/70. Conclusions An aggressive combination of therapeutic modalities, including the removal of subiris abscesses, might be needed for the successful resolution of Fusarium endophthalmitis.

[1]  Chun-Yuan Wang,et al.  Intracameral voriconazole injection in the treatment of fungal endophthalmitis resulting from keratitis. , 2010, American journal of ophthalmology.

[2]  H. Offret,et al.  Fusarium keratitis and endophthalmitis associated with lens contact wear , 2010, International Ophthalmology.

[3]  W. Mieler,et al.  Voriconazole in the treatment of fungal eye infections: a review of current literature , 2008, British Journal of Ophthalmology.

[4]  Russell N Van Gelder,et al.  Aqueous and vitreous concentrations following topical administration of 1% voriconazole in humans. , 2008, Archives of ophthalmology.

[5]  Chun-Yuan Wang,et al.  Clearance of intravitreal voriconazole. , 2007, Investigative ophthalmology & visual science.

[6]  E. Tu,et al.  Successful treatment of resistant ocular fusariosis with posaconazole (SCH-56592). , 2007, American journal of ophthalmology.

[7]  L. Gopal,et al.  INTRAVITREAL VORICONAZOLE FOR DRUG-RESISTANT FUNGAL ENDOPHTHALMITIS: Case Series , 2006, Retina.

[8]  K. Wannemuehler,et al.  Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution. , 2006, JAMA.

[9]  H. Flynn,et al.  Fusarium endophthalmitis following keratitis associated with contact lenses. , 2006, Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye.

[10]  H. Blau,et al.  Intravitreal voriconazole for the treatment of endogenous Aspergillus endophthalmitis. , 2006, Ophthalmology.

[11]  É. Magalhães,et al.  Chronic endophthalmitis due to verticillium species after cataract surgery treated (or managed) with pars plana vitrectomy and oral and intravitreal voriconazole. , 2006, Retina.

[12]  H. Taylor,et al.  Microbial Keratitis: Predisposing Factors and Morbidity , 2006 .

[13]  J. Alió,et al.  Endophthalmitis Caused by Fusarium proliferatum , 2005, Journal of Clinical Microbiology.

[14]  Ivana K. Kim,et al.  Successful treatment of Fusarium endophthalmitis with voriconazole and Aspergillus endophthalmitis with voriconazole plus caspofungin. , 2005, American journal of ophthalmology.

[15]  D. Eliott,et al.  Disseminated Fusarium infection presenting as bilateral endogenous endophthalmitis in a patient with acute myeloid leukemia. , 2005, Archives of ophthalmology.

[16]  W. Mieler,et al.  Management of endogenous fungal endophthalmitis with voriconazole and caspofungin. , 2005, American journal of ophthalmology.

[17]  S. Wu,et al.  Intravitreal voriconazole: an electroretinographic and histopathologic study. , 2004, Archives of ophthalmology.

[18]  J. Giaconi,et al.  In vitro investigation of voriconazole susceptibility for keratitis and endophthalmitis fungal pathogens. , 2004, American journal of ophthalmology.

[19]  H. Flynn,et al.  Delayed-onset, bleb-associated endophthalmitis caused by Lecythophora mutabilis. , 2004, American journal of ophthalmology.

[20]  Judy E. Kim,et al.  Determination of vitreous, aqueous, and plasma concentration of orally administered voriconazole in humans. , 2004, Archives of ophthalmology.

[21]  Darlene Miller,et al.  Advanced Fusarium Keratitis Progressing to Endophthalmitis , 2003, Cornea.

[22]  E. Donnenfeld,et al.  Topical Cyclosporin A in the Management of Therapeutic Keratoplasty for Mycotic Keratitis , 2002, Cornea.

[23]  G. Rao,et al.  Enzymatic, clinical and histologic evaluation of corneal tissues in experimental fungal keratitis in rabbits. , 2001, Experimental eye research.

[24]  D. Goldblum,et al.  Treatment of Postkeratitis Fusarium Endophthalmitis with Amphotericin B Lipid Complex , 2000, Cornea.

[25]  K. Tintelnot,et al.  Successful treatment of ocular invasive mould infection (fusariosis) with the new antifungal agent voriconazole , 2000, The British journal of ophthalmology.

[26]  Russell E. Lewis,et al.  Evaluation of Voriconazole Pharmacodynamics Using Time-Kill Methodology , 2000, Antimicrobial Agents and Chemotherapy.

[27]  C. Karp,et al.  Effects of methylprednisolone and cyclosporine A on fungal growth in vitro. , 1999, Cornea.

[28]  R. Eagle,et al.  Delayed-onset fungal keratitis after endophthalmitis. , 1998, Ophthalmology.

[29]  T. Wong,et al.  Fusarium keratitis following the use of topical antibiotic-corticosteroid therapy in traumatised eyes. , 1996, Annals of the Academy of Medicine, Singapore.

[30]  R. H. Rosa,et al.  The changing spectrum of fungal keratitis in south Florida. , 1994, Ophthalmology.

[31]  M. Elman,et al.  Endogenous Fusarium endophthalmitis in a patient with acute lymphocytic leukemia. , 1994, American journal of ophthalmology.

[32]  W. S. Head,et al.  Influence of corticosteroid on experimentally induced keratomycosis. , 1991, Archives of ophthalmology.

[33]  H. Flynn,et al.  Exogenous fungal endophthalmitis. , 1988, Ophthalmology.

[34]  L. B. Wingard,et al.  Amphotericin clearance in vitrectomized versus nonvitrectomized eyes. , 1985, Ophthalmology.

[35]  D. Smith,et al.  Fusarium oxysporum endophthalmitis. , 1979, Archives of ophthalmology.

[36]  A. Bron,et al.  Corneal and intra-ocular infection due to Fusarium solani. , 1970, Transactions of the ophthalmological societies of the United Kingdom.