THE BELGIAN OPHTHALMIC ASSOCIATIONS
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This abstract is assigned to session Poster session
| Title | A case of recalcitrant Aspergillus keratitis and endophthalmitis, treated with IV Caspofungine and PO Voriconazole |
| Abstract Nr. | P004 |
| Results | In June 2003 a patient undergoes cataractextraction OD by phaco through a clear cornea temporal incision. In August the patient is referred to us because of a corneal ulcer, temporally located. Scraping reveals the presence of Aspergillus fumigatus. Treatment is initiated with Amphotericin B drops 0,15% and Fluconazole per os 200 mg per day. The patient is still under Fluconazole when, in December, the infection spreads to the endothelial side of the cornea. Treatment : Natamycine drops hourly, Fluconazole is continued. The patient is still using Natamycine when she is rehospitalised in February 2004 for a third lesion and a hypopyon. A diagnostic vitrectomy is performed; Amphotericin B and Kenacort are injected into the vitreous. The endothelial surface of the cornea is wiped with a surgical sponge (positive for Aspergillus fumigatus) and Amphotericin B is injected into the anterior chamber. The department of microbiology suggests to us to try intravenous Caspofungine over a period of 10 days. Afterwards treatment with Natamycine drops and Fluconazole is continued, finally in April the third lesion has healed. A month later, in May, a fourth lesion develops, spreading on the inside of the cornea; a hypopyon is again present. Treatment this time consists of intravenous Caspofungin for 10 days, followed by Voriconazole per os for three weeks. After 3,5 months, the infection has not returned. |
| Conclusion | Caspofungine and Voriconazole are new antifungal agents for systemic treatment of invasive Aspergillose; their use in ocular infection is still under investigation. |
Author 1
| Last name | KOPPEN |
| Initials | C |
| Department | UZ |
| City | Antwerp |
Author 2
| Last name | TASSIGNON |
| Initials | MJ |
| Department | UZ |
| City | Antwerp |