Oral voriconazole use in the treatment of fungic endogenous endophthalmitis: case report

Poster Details

First Author: A.Sampaio PORTUGAL

Co Author(s):    P. Leit   P. Ferreira           

Abstract Details

Purpose:

The endogenous endoftalmitis is a serious intraocular infection, resulting from hematogenous spread of microorganisms from distant infectious foci. It is a relatively rare condition, accounting for about 2-8% of all cases of endophthalmitis and is associated with immunosuppression, organ deficiency, invasive procedures, abuse of illicit drugs, prematurity, and surgeries, especially abdominal. Fungi are the most common agents in endogenous endophthalmitis, Candida albicans being the species most frequently. The bilateral involvement in these cases is about 25%. The fungal endophthalmitis is presented in most cases as infection of indolent character. The most common symptoms are: blurred vision, pain, photophobia and miodesópsias. The most characteristic sign eye injury is white, just defined, involving the choroid and retina, at the posterior pole. It can be single or multiple, and there intraretinal hemorrhages surrounding the lessćo, the so-called Roth spots. The vitreous opacities are typically yellowish white, connected by beams, producing an image similar to a " string of pearls." The authors propose to present a clinical case of fungal endophthalmitis, post abdominal surgery complicated by fistula and prolonged use of intravenous catheter and treatment with oral voriconazole.

Setting:

Patient male, 65, was examined in the service of urgency by bilateral visual acuity from 2 months ago. He complained of miodesopsias and gradual loss of visual acuity. On examination: Bilateral visual acuity of 3/10, keratitis striated, Tyndall + + / 4 +. IOP 22 mmHg. Fundoscopy:right eye, vitritis 3 + / 4 +, with difficult visualization of retinal structures.Left eye:vitritis 2+/4+ several foci of retinitis, with yellowish white lesions, the largest along the inferior temporal arcade.

Methods:

It was proposed treatment with voriconazole oral dose of the 400mg, 12/12h for 24h, followed by 200mg of 12/12h, who performed for 4 weeks.

Results:

There was good response to treatment with resolution of the infection and final visual acuity of 10/10 bilaterally.

Conclusions:

Several recent studies have shown that the Oral Voriconazole has good intraocular penetrance, with therapeutic concentrations of intra-vitreous, and good oral bioavailability, which would make a good therapeutic option in the case of fungal endophthalmitis. In some cases, as in this without the use of intra-vitreous injections and / or vitrectomy. FINANCIAL DISCLOSURE?: No