Abstract
Exogenous fungal endophthalmitis (EXFE) represents a rare complication after penetrating ocular trauma of previously unresolved keratitis or iatrogenic infections, following intraocular surgery such as cataract surgery. The usual latency period between intraocular inoculation and presentation of symptoms from fungal endophthalmitis is several weeks to months as delayed-onset endophthalmitis. Aspergillus spp., is the most common causative mould pathogen implicated in this ocular infection and early diagnosis and prompt antimicrobial treatment, concomitantly in most cases with expert surgical attention, reduce unfavorable complications and increase the possibility of eye function preservation. Topical, intravitreal and systemic antifungal molecules are the mainstay of a medical approach to the disease and azoles, polyenes and in particular cases echinocandins are the pharmacological classes most commonly used in clinical practice. This review discusses pharmacokinetics and pharmacodynamic of antifungal agents in their principal modes of administration with a focus on their ability to achieve high drug concentration in the vitreous and ocular tissues.
Highlights
The term “endophthalmitis” is referred to one of the most striking eye infections due to infection of the ocular cavity and adjacent structures by fungi and bacteria
Asian studies have reported fungi as the causative organisms in approximately 11.1% to 17.54% of total cases of Exogenous endophthalmitis (EE), with the rest being attributed to bacterial causes [6]
We aimed to review current knowledge about exogenous fungal endophthalmitis (EXFE) due to Aspergillus spp. together with a focus on the pharmacokinetics (PK) and pharmacodynamics (PD) of antifungal agents in their principal route of administration
Summary
The term “endophthalmitis” is referred to one of the most striking eye infections due to infection of the ocular cavity and adjacent structures by fungi and bacteria. Most cases of endophthalmitis are exogenous, in which pathogens from an external source or on the ocular surface, are introduced into the eye. Account for 85% to 98% of all cases of endophthalmitis [1]. According to Rychener classification [5], exogenous fungal endophthalmitis (EXFE) occurs as a result of extension of keratomycosis, eye surgery, or penetrating ocular trauma. Over the last 20 years, from 8.6% to 18.6% of culturepositive cases. The clinical presentation of Aspergillus-EXFE may vary from an indolent, mild external disease to fulminant, necrotizing destruction of the globe [1].
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