Management of endogenou fungal endophthalmiti with voriconazole and capofungin

Purpoe Voriconazole, a new generation triazole, ha been hown to achieve therapeutic intraocular level after oral adminitration. Capofungin i the firt approved agent from a new cla of antifungal, the echinocandin. Thi erie decribe experience at two center uing thee novel antifungal to treat endogenou fungal endophthalmiti. Deign Retropective review. Method Treatment of five patient with Candida endophthalmiti are reviewed. Potmortem intraocular voriconazole concentration on a ixth patient are preented a well. Reult All patient had ytemic culture poitive for Candida pecie. Three patient had prompt reolution of intraocular mycoi with intravenou and oral voriconazole, capofungin, or both. The fourth patient with bilateral dieae reponded well to IV voriconazole and capofungin but had a recurrence when dicharged on oral voriconazole and IV capofungin. Thi patient had a bowel reection with an ileotomy; therefore, aborption of oral voriconazole may have been inadequate. Bilateral amphotericin B intravitreal injection ultimately treated thi patient. The fifth patient received 100 μg/0.1 ml of intravitreal voriconazole (final vitreou concentration approximately 25 μg/ml) followed by oral voriconazole and reponded favorably. Our ixth patient had multiytem failure and paed away 1 week after initiating intravenou voriconazole for non-ocular candidemia. Potmortem HPLC analyi of the aqueou and vitreou revealed voriconazole concentration of 1.52 μg/ml and 1.12 μg/ml, repectively (MIC90 of Candida albican i 0.06 μg/ml). Concluion Voriconazole and capofungin appear to be powerful weapon to add to the exiting armamentarium againt fungal endophthalmiti. Further tudie are warranted to define preciely the role of thee new agent alone or in combination with other antifungal.