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Harry W Flynn - One of the best experts on this subject based on the ideXlab platform.
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exogenous Fungal Endophthalmitis an analysis of isolates and susceptibilities to antiFungal agents over a 20 year period 1990 2010
American Journal of Ophthalmology, 2015Co-Authors: Ruwan A Silva, Darlene Miller, Charles C Wykoff, Jayanth Sridhar, Harry W FlynnAbstract:Purpose To describe the isolates and susceptibilities to antiFungal agents for patients with culture-proven exogenous Fungal Endophthalmitis. Design Noncomparative case series. Methods The clinical records of all patients treated for culture-proven exogenous Fungal Endophthalmitis at a university referral center from 1990 to 2010 were reviewed. Specimens initially used for diagnosis were recovered from the microbiology department and then underwent antiFungal sensitivity analysis. Results The antiFungal susceptibilities of 47 Fungal isolates from culture-positive Fungal Endophthalmitis are reported. Included are 14 isolates from yeast and 33 from mold. The mean (±standard deviation) minimum inhibitory concetrations (MICs) for amphotericin B (2.6 ± 3.5 μg/mL), fluconazole (36.9 ± 30.7 μg/mL), and voriconazole (1.9 ± 2.9 μg/mL) are reported. Presumed susceptibility to oral fluconazole, intravenous amphotericin B, intravitreal amphotericin B, oral voriconazole, and intravitreal voriconazole occurred in 34.8%-43.5%, 0-8.3%, 68.8%, 69.8%, and 100% of isolates, respectively. Conclusions Based on this laboratory study of isolates from exogenous Fungal Endophthalmitis, intravitreal voriconazole appears to provide the broadest spectrum of antiFungal coverage and, as such, may be considered for empiric therapy of Endophthalmitis caused by yeast or mold.
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endogenous Fungal Endophthalmitis risk factors clinical features and treatment outcomes in mold and yeast infections
Journal of Ophthalmic Inflammation and Infection, 2013Co-Authors: Jayanth Sridhar, Darlene Miller, Harry W Flynn, Ajay E Kuriyan, Thomas A AlbiniAbstract:Background The purpose of the current study was to analyze risk factors, clinical features, and treatment outcomes in patients with endogenous Fungal Endophthalmitis with yeast and mold infections. For this retrospective consecutive case series, microbiologic and clinical records were reviewed to identify all patients with intraocular culture-proven endogenous Fungal Endophthalmitis treated at a single institution between January 1, 1990 and December 31, 2011.
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endogenous Fungal Endophthalmitis causative organisms management strategies and visual acuity outcomes
American Journal of Ophthalmology, 2012Co-Authors: Ahila Lingappan, Thomas A Albini, Janet L Davis, Charles C Wykoff, Darlene Miller, Avinash Pathengay, Harry W FlynnAbstract:Purpose To report the causative organisms, management strategies, and visual outcomes in endogenous Fungal Endophthalmitis. Design Observational case series. Methods Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous Fungal Endophthalmitis between January 1, 1990, and July 1, 2009. Results Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up. Conclusions Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous Fungal Endophthalmitis. Endogenous Fungal Endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.
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exogenous Fungal Endophthalmitis microbiology and clinical outcomes
Ophthalmology, 2008Co-Authors: Charles C Wykoff, Harry W Flynn, Darlene Miller, Ingrid U Scott, Eduardo C AlfonsoAbstract:Objective To report the Fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous Fungal Endophthalmitis. Design Retrospective, single institution, consecutive case series. Participants All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous Fungal Endophthalmitis. Methods Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for Fungal organisms and clinically diagnosed exogenous Endophthalmitis. Main Outcome Measures Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results Culture-positive exogenous Fungal Endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with Fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antiFungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions This report highlights the differences between the clinical categories of exogenous Fungal Endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common Fungal genera varied by clinical category. Amphotericin B was the most commonly used antiFungal agent, but most cases were treated with at least 3 different antiFungal agents. Final visual outcomes were variable, with the open-globe–associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
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treatment outcomes in a 10 year study of endogenous Fungal Endophthalmitis
Ophthalmic Surgery and Lasers, 1997Co-Authors: Thomas F Essman, Harry W Flynn, William E Smiddy, Roy D Brod, Timothy G Murray, Janet L Davis, Patrick E RubsamenAbstract:. BACKGROUND AND OBJECTIVE: To review prevalence of organisms, associated factors, and treatment outcomes from one medical center's 10-year experience managing culture-proven endogenous Fungal Endophthalmitis (EFE). . PATIENTS AND METHODS: The authors retrospectively reviewed the microbiology and corresponding clinical records of patients diagnosed as having culture-proven EFE at the Bascom Palmer Eye Institute during a 10-year period. . RESULTS: Culture-proven EFE occurred in 20 eyes of 18 patients. Candida species occurred in 17 of 20 eyes (85%), and Aspergillus species occurred in 3 of 20 eyes (15%). The most common association was long-term intravenous line placement, which was present in 12 patients (67%). Whereas 12 patients (67%) had a history of recent hospitalization, only 2 (11%) had a documented history of systemic Fungal infection. After initial examination, only 2 patients had a systemic culture positive for a Fungal organism (none had a positive blood culture). Treatment after initial examination included pars plana vitrectomy in 17 of the 20 eyes (85%), intravitreal amphotericin B in 19 eyes (95%), and systemic antiFungal medication in 16 eyes of 15 patients. Thirteen of the 17 eyes (76%) with Candida Endophthalmitis and 0 of 3 eyes with Aspergillus Endophthalmitis achieved visual acuity of 20/400 or better. . CONCLUSIONS The most common cause of culture-proven EFE at the authors' institution is Candida species. The overall visual outcomes were more favorable for Candida cases than they were for Aspergillus cases. In the treatment of patients with marked vitreous infiltrates from EFE, pars plana vitrectomy, intravitreal amphotericin B injection, and administration of appropriate systemic antiFungal medication (fluconazole for Candida) are generally recommended.
Darlene Miller - One of the best experts on this subject based on the ideXlab platform.
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exogenous Fungal Endophthalmitis an analysis of isolates and susceptibilities to antiFungal agents over a 20 year period 1990 2010
American Journal of Ophthalmology, 2015Co-Authors: Ruwan A Silva, Darlene Miller, Charles C Wykoff, Jayanth Sridhar, Harry W FlynnAbstract:Purpose To describe the isolates and susceptibilities to antiFungal agents for patients with culture-proven exogenous Fungal Endophthalmitis. Design Noncomparative case series. Methods The clinical records of all patients treated for culture-proven exogenous Fungal Endophthalmitis at a university referral center from 1990 to 2010 were reviewed. Specimens initially used for diagnosis were recovered from the microbiology department and then underwent antiFungal sensitivity analysis. Results The antiFungal susceptibilities of 47 Fungal isolates from culture-positive Fungal Endophthalmitis are reported. Included are 14 isolates from yeast and 33 from mold. The mean (±standard deviation) minimum inhibitory concetrations (MICs) for amphotericin B (2.6 ± 3.5 μg/mL), fluconazole (36.9 ± 30.7 μg/mL), and voriconazole (1.9 ± 2.9 μg/mL) are reported. Presumed susceptibility to oral fluconazole, intravenous amphotericin B, intravitreal amphotericin B, oral voriconazole, and intravitreal voriconazole occurred in 34.8%-43.5%, 0-8.3%, 68.8%, 69.8%, and 100% of isolates, respectively. Conclusions Based on this laboratory study of isolates from exogenous Fungal Endophthalmitis, intravitreal voriconazole appears to provide the broadest spectrum of antiFungal coverage and, as such, may be considered for empiric therapy of Endophthalmitis caused by yeast or mold.
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endogenous Fungal Endophthalmitis risk factors clinical features and treatment outcomes in mold and yeast infections
Journal of Ophthalmic Inflammation and Infection, 2013Co-Authors: Jayanth Sridhar, Darlene Miller, Harry W Flynn, Ajay E Kuriyan, Thomas A AlbiniAbstract:Background The purpose of the current study was to analyze risk factors, clinical features, and treatment outcomes in patients with endogenous Fungal Endophthalmitis with yeast and mold infections. For this retrospective consecutive case series, microbiologic and clinical records were reviewed to identify all patients with intraocular culture-proven endogenous Fungal Endophthalmitis treated at a single institution between January 1, 1990 and December 31, 2011.
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endogenous Fungal Endophthalmitis causative organisms management strategies and visual acuity outcomes
American Journal of Ophthalmology, 2012Co-Authors: Ahila Lingappan, Thomas A Albini, Janet L Davis, Charles C Wykoff, Darlene Miller, Avinash Pathengay, Harry W FlynnAbstract:Purpose To report the causative organisms, management strategies, and visual outcomes in endogenous Fungal Endophthalmitis. Design Observational case series. Methods Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous Fungal Endophthalmitis between January 1, 1990, and July 1, 2009. Results Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up. Conclusions Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous Fungal Endophthalmitis. Endogenous Fungal Endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.
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exogenous Fungal Endophthalmitis microbiology and clinical outcomes
Ophthalmology, 2008Co-Authors: Charles C Wykoff, Harry W Flynn, Darlene Miller, Ingrid U Scott, Eduardo C AlfonsoAbstract:Objective To report the Fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous Fungal Endophthalmitis. Design Retrospective, single institution, consecutive case series. Participants All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous Fungal Endophthalmitis. Methods Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for Fungal organisms and clinically diagnosed exogenous Endophthalmitis. Main Outcome Measures Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results Culture-positive exogenous Fungal Endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with Fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antiFungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions This report highlights the differences between the clinical categories of exogenous Fungal Endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common Fungal genera varied by clinical category. Amphotericin B was the most commonly used antiFungal agent, but most cases were treated with at least 3 different antiFungal agents. Final visual outcomes were variable, with the open-globe–associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
Charles C Wykoff - One of the best experts on this subject based on the ideXlab platform.
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exogenous Fungal Endophthalmitis an analysis of isolates and susceptibilities to antiFungal agents over a 20 year period 1990 2010
American Journal of Ophthalmology, 2015Co-Authors: Ruwan A Silva, Darlene Miller, Charles C Wykoff, Jayanth Sridhar, Harry W FlynnAbstract:Purpose To describe the isolates and susceptibilities to antiFungal agents for patients with culture-proven exogenous Fungal Endophthalmitis. Design Noncomparative case series. Methods The clinical records of all patients treated for culture-proven exogenous Fungal Endophthalmitis at a university referral center from 1990 to 2010 were reviewed. Specimens initially used for diagnosis were recovered from the microbiology department and then underwent antiFungal sensitivity analysis. Results The antiFungal susceptibilities of 47 Fungal isolates from culture-positive Fungal Endophthalmitis are reported. Included are 14 isolates from yeast and 33 from mold. The mean (±standard deviation) minimum inhibitory concetrations (MICs) for amphotericin B (2.6 ± 3.5 μg/mL), fluconazole (36.9 ± 30.7 μg/mL), and voriconazole (1.9 ± 2.9 μg/mL) are reported. Presumed susceptibility to oral fluconazole, intravenous amphotericin B, intravitreal amphotericin B, oral voriconazole, and intravitreal voriconazole occurred in 34.8%-43.5%, 0-8.3%, 68.8%, 69.8%, and 100% of isolates, respectively. Conclusions Based on this laboratory study of isolates from exogenous Fungal Endophthalmitis, intravitreal voriconazole appears to provide the broadest spectrum of antiFungal coverage and, as such, may be considered for empiric therapy of Endophthalmitis caused by yeast or mold.
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endogenous Fungal Endophthalmitis causative organisms management strategies and visual acuity outcomes
American Journal of Ophthalmology, 2012Co-Authors: Ahila Lingappan, Thomas A Albini, Janet L Davis, Charles C Wykoff, Darlene Miller, Avinash Pathengay, Harry W FlynnAbstract:Purpose To report the causative organisms, management strategies, and visual outcomes in endogenous Fungal Endophthalmitis. Design Observational case series. Methods Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous Fungal Endophthalmitis between January 1, 1990, and July 1, 2009. Results Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up. Conclusions Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous Fungal Endophthalmitis. Endogenous Fungal Endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.
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exogenous Fungal Endophthalmitis microbiology and clinical outcomes
Ophthalmology, 2008Co-Authors: Charles C Wykoff, Harry W Flynn, Darlene Miller, Ingrid U Scott, Eduardo C AlfonsoAbstract:Objective To report the Fungal isolates, treatment strategies, and clinical outcomes for a large series of patients with exogenous Fungal Endophthalmitis. Design Retrospective, single institution, consecutive case series. Participants All patients treated at Bascom Palmer Eye Institute between January 1, 1990, and June 30, 2006, for culture-proven exogenous Fungal Endophthalmitis. Methods Microbiologic and medical records were reviewed for all patients with intraocular cultures positive for Fungal organisms and clinically diagnosed exogenous Endophthalmitis. Main Outcome Measures Fungal isolates, treatment strategies, visual acuity, and rate of enucleation. Results Culture-positive exogenous Fungal Endophthalmitis occurred in 41 eyes, including 18 cases (44%) associated with Fungal keratitis, 10 cases (24%) occurring after penetrating ocular trauma, and 13 cases (32%) after intraocular surgery. Filamentous fungi (molds) accounted for 35 cases (85%), and Candida species (yeasts) accounted for 6 cases (15%). Although most keratitis cases were caused by Fusarium (13 of 18; 72%), Aspergillus was the most common isolate in postoperative cases (5 of 13; 38%). Open-globe cases were caused by a broader spectrum of fungi. As initial treatment, 30 (73%) patients received intraocular amphotericin B, but at least 3 antiFungal agents were used in 24 (59%) cases. At least 1 pars plana vitrectomy was performed in 25 (61%) eyes, and 29 (71%) eyes underwent 3 or more procedures, including surgeries and intraocular injections. Although a final vision of 20/400 or better was achieved in 22 (54%) eyes, all but 1 of these were either in the keratitis (11 of 18) or the postoperative (10 of 13) groups. Conversely, although 10 (24%) of 41 eyes were enucleated, 7 of these were among the open-globe patients. Conclusions This report highlights the differences between the clinical categories of exogenous Fungal Endophthalmitis. Although 85% of all cases were caused by molds, most commonly Fusarium and Aspergillus, the most common Fungal genera varied by clinical category. Amphotericin B was the most commonly used antiFungal agent, but most cases were treated with at least 3 different antiFungal agents. Final visual outcomes were variable, with the open-globe–associated patients having the poorest outcomes. Overall, 44% of patients achieved a final visual acuity of 20/80 or better. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
Thomas A Albini - One of the best experts on this subject based on the ideXlab platform.
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endogenous Fungal Endophthalmitis risk factors clinical features and treatment outcomes in mold and yeast infections
Journal of Ophthalmic Inflammation and Infection, 2013Co-Authors: Jayanth Sridhar, Darlene Miller, Harry W Flynn, Ajay E Kuriyan, Thomas A AlbiniAbstract:Background The purpose of the current study was to analyze risk factors, clinical features, and treatment outcomes in patients with endogenous Fungal Endophthalmitis with yeast and mold infections. For this retrospective consecutive case series, microbiologic and clinical records were reviewed to identify all patients with intraocular culture-proven endogenous Fungal Endophthalmitis treated at a single institution between January 1, 1990 and December 31, 2011.
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endogenous Fungal Endophthalmitis causative organisms management strategies and visual acuity outcomes
American Journal of Ophthalmology, 2012Co-Authors: Ahila Lingappan, Thomas A Albini, Janet L Davis, Charles C Wykoff, Darlene Miller, Avinash Pathengay, Harry W FlynnAbstract:Purpose To report the causative organisms, management strategies, and visual outcomes in endogenous Fungal Endophthalmitis. Design Observational case series. Methods Microbiologic and medical records were reviewed retrospectively for all patients with culture-positive endogenous Fungal Endophthalmitis between January 1, 1990, and July 1, 2009. Results Study criteria were met in 65 eyes of 51 patients with mean follow-up of 18 months. Yeasts were the most common causative organism in 38 (75%) patients compared with molds in 13 (25%) patients. Retinal detachment occurred in 17 eyes (26%). Visual acuity of 20/200 or better was present in 28 (56%) eyes with yeasts and in 5 (33%) eyes with molds at the last follow-up. Conclusions Yeasts were the most common cause of culture-proven unilateral or bilateral endogenous Fungal Endophthalmitis. Endogenous Fungal Endophthalmitis generally is associated with poor visual acuity outcomes, especially when caused by molds. Retinal detachment is a frequent occurrence during follow-up.
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lemon juice and candida Endophthalmitis in crack cocaine misuse
British Journal of Ophthalmology, 2007Co-Authors: Thomas A Albini, Eric R Holz, Regina L Sun, Rahul N Khurana, Narsing A RaoAbstract:The Centers for Disease Control and Prevention recently reported that a substantial number of drug misusers in the US are injecting crack-cocaine instead of smoking it,1 owing to the decreased availability and increased cost of powdered cocaine. The use of lemon juice to dissolve crack-cocaine has been shown to cause abscesses, permanent vein damage and infections.2 Furthermore, heroin dissolved in preserved lemon juice was documented to be a source of Candida albicans in multiple, small epidemics of Fungal Endophthalmitis in the 1980s in the UK and Australia.3,4 We report here two recent cases of Fungal Endophthalmitis in crack users who similarly disclose dissolving crack-cocaine in lemon juice injection. A 34-year-old male intravenous drug user presented to his primary care physician with high fever …
Seenu M Hariprasad - One of the best experts on this subject based on the ideXlab platform.
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Voriconazole in the treatment of Fungal eye infections: a review of current literature.
British Journal of Ophthalmology, 2008Co-Authors: Seenu M Hariprasad, William F Mieler, T. K. Lin, William E. Sponsel, J R GraybillAbstract:Background: Voriconazole has an important role to play in the prophylaxis and management of Fungal Endophthalmitis and keratitis. New-generation triazoles, including voriconazole, posaconazole and ravuconazole, have been shown in laboratory studies and clinical experience to have very good safety profiles with few side effects. Fungal eye infections, while not common in temperate climates, have been notoriously difficult to diagnose and treat, and generally result in protracted therapy with poor final outcomes. Current treatment options are far from optimal. Aims: This paper will review studies and clinical case reports published in the ophthalmic literature that address the safety of these drugs in the eye, penetration and concentration in ocular tissues and media, and efficacy in treating common pathogens implicated in Fungal keratitis and Endophthalmitis. Conclusions: Over 40 clinical case reports of treatment with voriconazole suggest that it may be used safely and effectively against a broad range of Fungal pathogens.
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successful treatment of postoperative Fungal Endophthalmitis using intravitreal and intracameral voriconazole
Journal of Ocular Pharmacology and Therapeutics, 2008Co-Authors: Neeraj Sanduja, Seenu M HariprasadAbstract:Aim: The aim of this study was to describe 3 cases of postoperative Fungal Endophthalmitis successfully treated with anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection. Results: Three (3) patients from a single retina center in India developed culture-proven Fungal Endophthalmitis after cataract surgery in 1 eye. All patients underwent anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injections intraoperatively. All cases demonstrated substantial improvement in vision and intraocular inflammation after surgery. Conclusions: The combination of anterior chamber washout, pars plana vitrectomy, and intracameral and intravitreal voriconazole injection is a viable therapeutic option in cases of Fungal Endophthalmitis.
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aqueous and vitreous concentrations following topical administration of 1 voriconazole in humans
Archives of Ophthalmology, 2008Co-Authors: Atma G Vemulakonda, Seenu M Hariprasad, William F Mieler, Gaurav K Shah, Randall A Prince, Russell N Van GelderAbstract:Objective To determine the penetration of 1% voriconazole solution into the aqueous and vitreous following topical administration. Methods A prospective nonrandomized study of 13 patients scheduled for pars plana vitrectomy surgery. Aqueous and vitreous samples were obtained and analyzed after topical administration of 1% voriconazole every 2 hours for 24 hours before surgery. Drug concentration quantitation was performed using high-performance liquid chromatography. Results The mean (SD) sampling time after topical administration of the last voriconazole dose was 24 (14) minutes. The mean (SD) voriconazole concentrations in the aqueous and vitreous were 6.49 (3.04) μg/mL and 0.16 (0.08) μg/mL, respectively. Aqueous concentrations exceeded the minimum inhibitory concentration at which 90% of isolates are inhibited (MIC 90 ) for a wide spectrum of fungi and mold, including Aspergillus , Fusarium , and Candida species. Vitreous concentrations of voriconazole exceeded the MIC 90 for Candida albicans . Conclusion Topically administered voriconazole achieves therapeutic concentrations in the aqueous of the noninflamed human eye for many fungi and molds and achieves therapeutic levels in the vitreous for Candida species. Topical voriconazole may be a useful agent for the management of Fungal keratitis and for prophylaxis against the development of Fungal Endophthalmitis.
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management of endogenous Fungal Endophthalmitis with voriconazole and caspofungin
American Journal of Ophthalmology, 2005Co-Authors: Sean M Breit, Seenu M Hariprasad, William F Mieler, Gaurav K Shah, Michael D Mills, Gilbert M GrandAbstract:Purpose Voriconazole, a new generation triazole, has been shown to achieve therapeutic intraocular levels after oral administration. Caspofungin is the first approved agent from a new class of antiFungals, the echinocandins. This series describes experience at two centers using these novel antiFungals to treat endogenous Fungal Endophthalmitis. Design Retrospective review. Methods Treatment of five patients with Candida Endophthalmitis are reviewed. Postmortem intraocular voriconazole concentrations on a sixth patient are presented as well. Results All patients had systemic cultures positive for Candida species. Three patients had prompt resolution of intraocular mycosis with intravenous and oral voriconazole, caspofungin, or both. The fourth patient with bilateral disease responded well to IV voriconazole and caspofungin but had a recurrence when discharged on oral voriconazole and IV caspofungin. This patient had a bowel resection with an ileostomy; therefore, absorption of oral voriconazole may have been inadequate. Bilateral amphotericin B intravitreal injection ultimately treated this patient. The fifth patient received 100 μg/0.1 ml of intravitreal voriconazole (final vitreous concentration approximately 25 μg/ml) followed by oral voriconazole and responded favorably. Our sixth patient had multisystem failure and passed away 1 week after initiating intravenous voriconazole for non-ocular candidemia. Postmortem HPLC analysis of the aqueous and vitreous revealed voriconazole concentrations of 1.52 μg/ml and 1.12 μg/ml, respectively (MIC90 of Candida albicans is 0.06 μg/ml). Conclusions Voriconazole and caspofungin appear to be powerful weapons to add to the existing armamentarium against Fungal Endophthalmitis. Further studies are warranted to define precisely the role of these new agents alone or in combination with other antiFungals.
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determination of vitreous aqueous and plasma concentration of orally administered voriconazole in humans
Archives of Ophthalmology, 2004Co-Authors: Seenu M Hariprasad, Eric R Holz, William F Mieler, H Gao, Judy E Kim, Jingduan Chi, Randall A PrinceAbstract:plasma voriconazole concentration achieved in the vitreous and aqueous were 38.1% and 53.0%, respectively. Mean vitreous and aqueous minimum inhibitory concentrations for 90% of isolates (MIC90) were achieved against a wide spectrum of yeasts and molds, including Aspergillus species andCandida species, along with many other organisms. Conclusions: Orally administered voriconazole achieves therapeutic aqueous and vitreous levels in the noninflamed human eye, and the activity spectrum appears to appropriately encompass the most frequently encountered mycotic species involved in the various causes of Fungal Endophthalmitis. Because of its broad spectrum of coverage, low MIC90 levels for the organisms of concern, good tolerability, and excellent bioavailability with oral administration, it may represent a major advance in the prophylaxis or management of exogenous or endogenous Fungal Endophthalmitis.
