Fungal
- Etiologies include:
- chronic post-surgical
- penetrating ocular trauma due to vegetation
hematogenous - patients with current or recently removed central venous catheters are at particular risk for candida endophthalmitis
- Ophthalmology and Infectious Diseases consults recommended.
- Vitrectomy may be required.
- Neither posaconazole nor echinocandins achieve adequate therapeutic concentrations in the vitreous.
Usual Pathogens
Candida spp
Aspergillus spp
Candida spp
Systemic therapy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Fluconazole |
12mg/kg loading dose IV/PO once, then 6-12mg/kg IV/PO daily |
4-12 weeks dependent on clinical picture |
| or | ||
| Voriconazole |
400mg (6mg/kg) IV/PO q12h x 2 doses, then 200-300mg (4mg/kg) IV/PO q12h |
4-12 weeks dependent on clinical picture |
| Fluconazole and voriconazole resistance | ||
| [Amphotericin B, liposomal | 3-5mg/kg IV daily | 4-12 weeks dependent on clinical picture |
| +/- | ||
| Flucytosine] | 25mg/kg PO qid |
PLUS if Candida chorioretinitis with macular involvement or with vitritis:
Ophthalmic Preparations
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole 100mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |
| or | ||
| Amphotericin B 5mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |
Aspergillus spp
Systemic therapy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole |
400mg (6mg/kg) IV/PO q12h x 2 doses, then 200-300mg (4mg/kg) IV/PO q12h |
4-12 weeks dependent on clinical picture |
PLUS:
Ophthalmic Preparations
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole 100mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |
| or | ||
| Amphotericin B 5mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |