Rosie Dawkins, Jonathan Kam, Penelope Allen
Voriconazole is an effective broad-spectrum anti-fungal agent. It has been shown to be safe for intravitreal injection at standard doses, and to reach effective vitreous concentrations when administered orally. To date no large prospective series using vori-conazole for fungal endophthalmitis of all causes have been published.
A prospective case series of all cases of fungal endophthalmitis treated at the Royal Victorian Eye and Ear Hospital starting from the first use of voriconazole for fungal endophthalmitis in January 2007 until May 2012. Patients were treated with either intravitreal or oral voriconazole, or both or neither. Topical voriconazole was also available for cases of fungal keratitis. Outcome measures collected include visual outcome, vitrectomy rate, and microbiological spectrum.
57 sequential cases were collected. 37 grew fungal organisms, 4 were not biopsied due to a con-vincing clinical picture. Of the patients who were treated with voriconazole, 12 received oral, 6 received intravitreal, 1 both oral and intravitreal, and 1 received topical. 23 vitrectomies were performed. 41% for whom final visual acuities (VA) were available achieved a final VA of better than or equal to 6/18.
Voriconazole is a safe and effective treat-ment for fungal endophthalmitis. It is remarkably flex-ible as it can be used as an oral or intravitreal forms. It can also be used in combination with topical vori-conazole in endophthalmitis associated with fungal keratitis. Voriconazole shows great promise for the future treatment of clinically diagnosed fungal endo-phthalmitis without the need for intravitreal injections due to its effective vitreous penetration and broad-spectrum activity.