Fungal
- Etiologies include:
- chronic post-surgical
- penetrating ocular trauma due to vegetation
- hematogenous.
- Vitrectomy may be required.
- Neither posaconazole nor echinocandins achieve adequate therapeutic concentrations in the vitreous.
Usual Pathogens
Candida spp
Aspergillus spp
Fusarium spp
Systemic therapy
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Fluconazole | 6-12mg/kg IV/PO daily | 4-12 weeks dependent on clinical picture |
| or | ||
| Voriconazole | 200mg IV/PO q12h | 4-12 weeks dependent on clinical picture |
| or | ||
| Amphotericin B | 0.7-1mg/kg IV daily | 4-12 weeks dependent on clinical picture |
| + |
Ophthalmic Preparations
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole 100mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |
| or | ||
| Amphotericin B 5mcg/0.1mL | 0.1mL intravitreally | Single dose; repeat dosing highly controversial |