Voriconazole Eye Drops in the Management of Fungal Endophthalmitis

Abstract

Background: Managing fungal infections involving deeper ocular structures such as fungal endophthalmitis remains a challenge whereby patients with fungal endophthalmitis often have a poor visual outcome. Indeed, alternative treatments are needed. We investigated the feasibility of using topically applied voriconazole in the management of fungal endophthalmitis. Methods: In a prospective open label study, 10 participants were recruited from patients scheduled to undergo elective, posterior segment surgery. Participants received topical 1% voriconazole solution, preserved with 0.01% benzalkonium chloride, hourly for 4 doses or four times a day (qid) for 3 days. Vitreous humour was removed during surgery and analysed by HPLC. Results: The mean voriconazole concentration after hourly dosing (n = 5) was 0.4± 0.4 g/mL and the mean sampling time was 2.2± 1.9 h. Almost all the voriconazole concentrations from the qid regimen (n = 5) were < 0.1 g/mL. Discussion: The data suggest that hourly dosing is likely to give adequate concentration required to treat infections associated with most Candida species but not Aspergillus or Fusarium species. Conclusion: Topical application of 1% voriconazole eye drops is able to penetrate into the vitreous humour and may be useful as an adjunct to intra-vitreal and systemic voriconazole in the treatment of fungal endophthalmitis.