Intravitreal liposomal amphotericin B for treatment of endogenous candida endophthalmitis

Abstract

PURPOSE: To evaluate the outcomes of intravitreal liposomal amphotericin B (L-AmB) for treatment of endogenous candida endophthalmitis.

METHODS: Medical records of four patients with endogenous candida endophthalmitis treated with intravitreal L-AmB injection alone or combined with vitrectomy were reviewed.

RESULTS: Endogenous candida endophthalmitis developed in two patients after gastrointestinal surgery, in one patient with sepsis, and in one patient undergoing systemic chemotherapy for metastatic breast cancer. Three eyes of two patients exhibited toxic uveitis following repetitive intravitreal injection of amphotericin B deoxycholate (AmB-D, 10 μg/0.1 ml). The other patients had general health issues that restricted the use of AmB-D due to the potential risk of systemic toxicity. Seven eyes underwent intravitreal injection of L-AmB (10 μg/0.1 ml) with or without vitrectomy. In these patients, intraocular inflammation and vitreous opacities resolved, and chorioretinal infiltrates evolved into fibrotic scars. Visual acuity improved and stabilized in all eyes during the follow-up period.

CONCLUSIONS: Intravitreal L-AmB seems to be well tolerated and effective in the treatment of endogenous candida endophthalmitis, and may be a reasonable alternative for patients who cannot endure the side effects or toxicity associated with conventional AmB-D therapy.