Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia.
Medicine (Baltimore). 2021 Apr 9;100(14):e25459. doi: 10.1097/MD.0000000000025459.
Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcome.
A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks' course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans. Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes.
He was diagnosed with EFE but the condition responded poorly with the medications.
He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed.
At 3 months' follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes.
Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.
内源性真菌性眼内炎（EFE）是系统性真菌血症引起的一种威胁视力的并发症。随着患病率的上升，治疗仍然是一个挑战，特别是在一线治疗失败或出现耐药真菌时。本病例报告研究了一例慢性 EFE，重点介绍了诊断程序、治疗选择、监测参数和治疗结果。
一名 64 岁男性，患有基础控制良好的糖尿病，因肾盂肾炎接受了 2 周的氟康唑静脉抗真菌治疗，因为他的血培养出了白色念珠菌。同时，他主诉双眼有 3 个月的无痛性进行性视力模糊。就诊时，他的双眼视力均为光感。眼部检查显示双眼非肉芽肿性炎症伴致密玻璃体炎。
他被诊断为 EFE，但药物治疗效果不佳。
他接受了玻璃体内（IVT）两性霉素 B 治疗，并继续使用氟康唑。进行了玻璃体切除术，术中发现双眼玻璃体和视网膜中有真菌球，左眼有黄斑牵引。术后，右眼视力为 6/24，N8，左眼视力为 2/60，N 无法测量，左眼有广泛的黄斑瘢痕和孔。玻璃体培养阴性。他多次接受 IVT 两性霉素 B 治疗，并开始使用局部皮质类固醇滴眼液治疗持续性全葡萄膜炎，同时口服氟康唑。转换为 IVT 和局部伏立康唑后，眼部情况有所改善。尽管如此，他的眼部状况仍恶化，并出现新生血管性青光眼，需要 3 种局部抗青光眼药物。随后进行了全视网膜光凝。
在 3 个月的随访中，他的右眼视力仍为 6/24，左眼视力为 2/60。双眼均无炎症或感染复发。
伏立康唑可作为一种有前途的广谱三唑类药物，用于一线治疗失败或出现耐药真菌的病例。
