Khan Fida A, Slain Douglas, Khakoo Rashida A
Section of Infectious Diseases, Ohio Valley Medical Center, Wheeling, West Virginia, USA.
Pharmacotherapy. 2007 Dec;27(12):1711-21. doi: 10.1592/phco.27.12.1711.
Candida endophthalmitis is a sight-threatening manifestation of disseminated candidiasis. The occurrence of endogenous candida endophthalmitis in patients with candidemia has ranged from 0-45% in the published literature. In critically ill patients, it has even been associated with increased mortality. In recent years, use of newer antifungal therapies for invasive candidiasis has increased given the rise in infections with non-albicans species of Candida. To identify current practices of the management of endogenous candida endophthalmitis and relevant antifungal drug research in this disease state, we conducted a MEDLINE search (1967-2006) and bibliographic search of the English-language literature. Treatments for candida endophthalmitis have not been evaluated through well-designed, well-powered clinical trials. Data have mainly been presented in case reports, case series, animal studies, pharmacokinetic studies, and as small subsets of larger trials. Traditional systemic therapies have been amphotericin B with or without flucytosine or fluconazole. Cure rates with antifungal drugs alone appear to be much higher in patients with chorioretinitis than in endophthalmitis with vitreal involvement. Pars plana vitrectomy with or without intravitreal amphotericin B injections has been advocated particularly for patients with moderate-to-severe vitritis and substantial vision loss. Information on new antifungal agents for endophthalmitis is limited, despite increasing use in patients with candidemia. Voriconazole may be a particularly attractive agent to consider for infections with fluconazole-resistant, voriconazole-susceptible strains. The current patchwork of animal studies and small patient reports provide clinicians with some insight into the role of newer agents in the treatment of candida endophthalmitis. In general, it appears that chorioretinitis infections can be more readily cured with most systemic antifungal agents, whereas more aggressive treatment, often including vitrectomy with or without intra-vitreal antifungal administration, is needed for patients with endophthalmitis with vitritis.
念珠菌性眼内炎是播散性念珠菌病的一种威胁视力的表现形式。在已发表的文献中，念珠菌血症患者发生内源性念珠菌性眼内炎的比例为0%至45%。在重症患者中，它甚至与死亡率增加相关。近年来，鉴于非白色念珠菌属感染的增加，用于侵袭性念珠菌病的新型抗真菌疗法的使用有所增加。为了确定内源性念珠菌性眼内炎的当前管理实践以及针对这种疾病状态的相关抗真菌药物研究，我们对MEDLINE（1967 - 2006年）进行了检索，并对英文文献进行了书目检索。念珠菌性眼内炎的治疗尚未通过设计良好、样本量充足的临床试验进行评估。数据主要呈现在病例报告、病例系列、动物研究、药代动力学研究以及大型试验的小部分亚组中。传统的全身治疗方法是使用两性霉素B，可联合或不联合氟胞嘧啶或氟康唑。单独使用抗真菌药物时，脉络膜视网膜炎患者的治愈率似乎比玻璃体受累的眼内炎患者高得多。对于中度至重度玻璃体炎和严重视力丧失的患者，尤其提倡行玻璃体切割术，可联合或不联合玻璃体内注射两性霉素B。尽管念珠菌血症患者对新型抗真菌药物的使用有所增加，但关于眼内炎新型抗真菌药物的信息有限。对于氟康唑耐药、伏立康唑敏感菌株的感染，伏立康唑可能是一种特别有吸引力的药物。目前动物研究和小样本患者报告的拼凑情况为临床医生提供了一些关于新型药物在念珠菌性眼内炎治疗中作用的见解。一般来说，似乎大多数全身抗真菌药物更容易治愈脉络膜视网膜炎感染，而对于伴有玻璃体炎的眼内炎患者，则需要更积极的治疗，通常包括玻璃体切割术联合或不联合玻璃体内抗真菌药物给药。
