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