“Treat and Extend” amphotericin B in post-op DMEK fungal endophthalmitis

Abstract

Purpose: The purpose of this study was to describe a case of post DMEK-fungal endophthalmitis treated with “treat and extend” amphotericin B, a method not fully described in the literature. Methods: We conducted an extensive retrospective chart review to create this case report. Results: An 85-year-old female with a history of Descemet membrane endothelial keratoplasty (DMEK) and positive yeast growth in the donor tissue presented with clinical signs of endophthalmitis. The culture samples were positive for Candida glabrata, indicating fungal endophthalmitis. Amphotericin B was administered because of its strain’s resistance to azole-like medications. The patient was closely followed every month, then two months, then every ten weeks with persistence of infection with intermittent flare-ups and continues to receive amphotericin B to temporarily reduce ocular symptoms. Conclusions: “Treat and extend” with amphotericin B is an alternative method of care for post-DMEK fungal endophthalmitis with the goal of temporary resolution of symptoms and maintenance of vision.