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