Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia.
J Ocul Pharmacol Ther. 2011 Feb;27(1):105-7. doi: 10.1089/jop.2010.0117. Epub 2011 Jan 16.
To report a case of bilateral endogenous candida endophthalmitis treated with intravenous fluconazole.
A 54-year-old man with poorly controlled diabetes presented with blurring of vision in both eyes, associated with eye pain for the past 2 months. Ocular examination revealed vision RE 4/60 ph 6/24, left eye (LE) 3/60. Anterior chamber examination showed 2+ anterior chamber cells in the LE. A streak of hypopyon was also noted in the LE. Both fundi showed presence of vitritis and white opacities. Proliferative diabetic retinopathy was present bilaterally. A diagnosis of bilateral endogenous endophthalmitis was made.
The patient was empirically treated with intravitreal vancomycin/ceftazidime on 3 consecutive days pending culture and sensitivity result. Blood and urine samples were negative for organisms. Vitreous samples were taken at the first intravitreal. The culture and sensitivity report of the vitreous sample was positive for candida albicans, which was sensitive to fluconazole. The patient was commenced on intravenous fluconazole 400 mg daily. The patient underwent core vitrectomy in the LE. Fluconazole was continued for 4 weeks, and he showed dramatic improvement with vision 6/12 in both eyes (OU) and endophthalmitis completely resolved.
There should be high index of suspicion of fungal endophthalmitis in patients with immune-compromised state even with no known septic foci.
报告一例经静脉氟康唑治疗的双侧内源性念珠菌性眼内炎。
一名 54 岁男性，患有未控制的糖尿病，双眼视力模糊伴眼痛 2 个月。眼部检查显示右眼视力 4/60，左眼 3/60。前房检查显示左眼有 2+前房细胞。左眼还可见一条灰白色积脓。双眼眼底均可见玻璃体炎症和白色混浊。双侧均有增殖性糖尿病性视网膜病变。诊断为双侧内源性眼内炎。
患者在等待培养和药敏结果的情况下，连续 3 天接受了玻璃体腔万古霉素/头孢他啶经验性治疗。血和尿标本均未检出病原体。第 1 次玻璃体腔取材进行了玻璃体培养，结果显示白色念珠菌阳性，对氟康唑敏感。患者开始每日静脉滴注氟康唑 400mg。左眼行核心玻璃体切除术。氟康唑继续使用 4 周，双眼视力均显著提高至 6/12，眼内炎完全消退。
即使没有已知的感染灶，免疫功能低下的患者也应高度怀疑真菌性眼内炎。
