Abstract
Objective: To describe the clinical courses of patients who received intravitreal injections of highly concentrated amphotericin B deoxycholate for suspected fungal endophthalmitis. Methods: Retrospective medical record review of 3 cases of intraocular toxicity from highly concentrated amphotericin B. Results:Thefirst patient developed posttraumaticendophthalmitis and received an undiluted dose (500 μg) of amphotericin B. He developed severe intraocular inflammation and required a pars plana lensectomy, vitrectomy, and scleral buckle after developing a cataractandretinal detachment. Six years later, his visual acuity stabilized at 20/30. Thesecond patient developed endogenous endophthalmitis and was treated with 5 intravitreal injections of amphotericin B and underwent 3 surgical procedures.Thesurgeon later discovered that the patient had received 55 μg of amphotericin B during the second injection. Three months after the injection, the patient's visual acuity was 20/60. The third patient developed chronic postoperative endophthalmitis following cataract extraction. He received 160 μg of amphotericin B and was immediately treated with a vitreous washout. Two years later, his visual acuity improved to 20/30. The vitreous culture results were negative in each case. A key finding was that the amphotericin B solution appeared to be yellow instead of nearly colorless. Conclusions: We present 3 cases of intraocular toxicity from highly concentrated amphotericin B. In every case, the overly concentrated amphotericin B solution was yellow in color. Although severe noninfectious panophthalmitis resulted in every case, the visual acuity outcomes were good. Physicians should examine the color of amphotericin B solution prior to intraocular administration. If the solution appears to be yellow, the medication should not be injected.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1546-1550 |
| Number of pages | 5 |
| Journal | Archives of ophthalmology |
| Volume | 128 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2010 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Ophthalmology
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Concentrated intravitreal amphotericin B in fungal endophthalmitis. / Payne, John F.; Keenum, Deborah G.; Sternberg, Paul; Thliveris, Andrew; Kala, Aaron; Olsen, Timothy.
In: Archives of ophthalmology, Vol. 128, No. 12, 01.12.2010, p. 1546-1550.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Concentrated intravitreal amphotericin B in fungal endophthalmitis
AU - Payne, John F.
AU - Keenum, Deborah G.
AU - Sternberg, Paul
AU - Thliveris, Andrew
AU - Kala, Aaron
AU - Olsen, Timothy
PY - 2010/12/1
Y1 - 2010/12/1
N2 - Objective: To describe the clinical courses of patients who received intravitreal injections of highly concentrated amphotericin B deoxycholate for suspected fungal endophthalmitis. Methods: Retrospective medical record review of 3 cases of intraocular toxicity from highly concentrated amphotericin B. Results:Thefirst patient developed posttraumaticendophthalmitis and received an undiluted dose (500 μg) of amphotericin B. He developed severe intraocular inflammation and required a pars plana lensectomy, vitrectomy, and scleral buckle after developing a cataractandretinal detachment. Six years later, his visual acuity stabilized at 20/30. Thesecond patient developed endogenous endophthalmitis and was treated with 5 intravitreal injections of amphotericin B and underwent 3 surgical procedures.Thesurgeon later discovered that the patient had received 55 μg of amphotericin B during the second injection. Three months after the injection, the patient's visual acuity was 20/60. The third patient developed chronic postoperative endophthalmitis following cataract extraction. He received 160 μg of amphotericin B and was immediately treated with a vitreous washout. Two years later, his visual acuity improved to 20/30. The vitreous culture results were negative in each case. A key finding was that the amphotericin B solution appeared to be yellow instead of nearly colorless. Conclusions: We present 3 cases of intraocular toxicity from highly concentrated amphotericin B. In every case, the overly concentrated amphotericin B solution was yellow in color. Although severe noninfectious panophthalmitis resulted in every case, the visual acuity outcomes were good. Physicians should examine the color of amphotericin B solution prior to intraocular administration. If the solution appears to be yellow, the medication should not be injected.
AB - Objective: To describe the clinical courses of patients who received intravitreal injections of highly concentrated amphotericin B deoxycholate for suspected fungal endophthalmitis. Methods: Retrospective medical record review of 3 cases of intraocular toxicity from highly concentrated amphotericin B. Results:Thefirst patient developed posttraumaticendophthalmitis and received an undiluted dose (500 μg) of amphotericin B. He developed severe intraocular inflammation and required a pars plana lensectomy, vitrectomy, and scleral buckle after developing a cataractandretinal detachment. Six years later, his visual acuity stabilized at 20/30. Thesecond patient developed endogenous endophthalmitis and was treated with 5 intravitreal injections of amphotericin B and underwent 3 surgical procedures.Thesurgeon later discovered that the patient had received 55 μg of amphotericin B during the second injection. Three months after the injection, the patient's visual acuity was 20/60. The third patient developed chronic postoperative endophthalmitis following cataract extraction. He received 160 μg of amphotericin B and was immediately treated with a vitreous washout. Two years later, his visual acuity improved to 20/30. The vitreous culture results were negative in each case. A key finding was that the amphotericin B solution appeared to be yellow instead of nearly colorless. Conclusions: We present 3 cases of intraocular toxicity from highly concentrated amphotericin B. In every case, the overly concentrated amphotericin B solution was yellow in color. Although severe noninfectious panophthalmitis resulted in every case, the visual acuity outcomes were good. Physicians should examine the color of amphotericin B solution prior to intraocular administration. If the solution appears to be yellow, the medication should not be injected.
UR - http://www.scopus.com/inward/record.url?scp=78650156330&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78650156330&partnerID=8YFLogxK
U2 - 10.1001/archophthalmol.2010.305
DO - 10.1001/archophthalmol.2010.305
M3 - Article
C2 - 21149777
AN - SCOPUS:78650156330
VL - 128
SP - 1546
EP - 1550
JO - JAMA Ophthalmology
JF - JAMA Ophthalmology
SN - 2168-6165
IS - 12
ER -