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.