Successful treatment of fungal endophthalmitis using intravitreal caspofungin

Arq Bras Oftalmol. 2017 Jun;80(3):196-198. doi: 10.5935/0004-2749.20170048.

Abstract

Fungal endophthalmitis is a rare condition often associated with poor prognosis. We present a case of postoperative acute fungal endophthalmitis caused by the yeast-like fungus Stephanoascus ciferrii (Candida ciferrii). The fungus was resistant to fluconazole, voriconazole, and amphotericin B but susceptible to caspofungin. Because the degree of vitreal penetration of caspofungin after its intravenous administration is unclear, we performed multiple intravitreal injections, first with 50 µg/0.1 ml and then with 250 µg/0.1 ml caspofungin. Despite the recurrence of symptoms, intravitreal injection of caspofungin finally abolished the inflammation and achieved ambulatory vision that persisted until 1 year of follow-up. To our knowledge, this is the first report of S. ciferrii endophthalmitis and its successful treatment with intravitreal caspofungin.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / administration & dosage*
  • Caspofungin
  • Echinocandins / administration & dosage*
  • Endophthalmitis / drug therapy*
  • Endophthalmitis / microbiology*
  • Eye Infections, Fungal / drug therapy*
  • Female
  • Humans
  • Intravitreal Injections*
  • Lipopeptides / administration & dosage*
  • Middle Aged
  • Phacoemulsification / adverse effects
  • Reproducibility of Results
  • Saccharomycetales
  • Treatment Outcome
  • Visual Acuity
  • Vitrectomy

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Caspofungin