TREATMENT OF PRESUMED FUNGAL ENDOPHTHALMITIS WITH ORAL FLUCONAZOLE

Amphotericin B is the usual treatment for fungal endophthalmitis, but its toxicity and lack of oral bioavailability may limit its use in som e patients. The authors report the successful management of two cases of presumed metastatic fungal endophthalmitis with oral fluconazole, a bis-triazole compound with a broad antifungal spectrum. [Ophthalmic S urg Lasers 1996;27:628-631.] Conventional management of fungal endopht halmitis consists of intravenous amphotericin B and, in selected cases , pars plana vitrectomy with or without intravitreal amphotericin B. H owever, problems encountered with the use of amphotericin B include po or oral bioavailability (necessitating intravenous administration), a relatively high incidence of renal toxicity, poor penetration of the b lood-ocular barrier (even in the presence of inflammation), and ocular toxicity, including retinal necrosis and detachment.(1-4) In this pap er, fluconazole, a bis-triazole compound with a broad antifungal spect rum,(5-10) is shown to successfully manage two cases of presumed endog enous fungal endophthalmitis. We emphasize that the diagnosis in these cases was not confirmed with cultures, however, and an endogenous uve itis could not be excluded.