Endogenous fungal endophthalmitis

Management

Tissue Penetration

• Penetration of antifungals into the vitreous is variable, though increases with inflammation
• Amphotericin B has poor penetration into the vitreous, with liposomal better than non-liposomal
  • It can be given intravitreally 5 to 10 μg of AmB-D as adjunctive therapy
• Flucytosine has excellent penetration
• Azoles
  • Fluconazole has good penetration, reaching intravitreal levels of 70% those in plasma
  • Voriconazole reaches 38% in non-inflamed eyes, and can also be given intravitreally up to 25 μg/mL
  • Unclear other azoles
• Echinocandins have poor ocular penetration and are not recommended