Concentrated intravitreal amphotericin B in fungal endophthalmitis

John F. Payne, Deborah G. Keenum, Paul Sternberg, Andrew Thliveris, Aaron Kala, Timothy Olsen

Research output: Contribution to journalArticle

10 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1546-1550
Number of pages5
JournalArchives of ophthalmology
Volume128
Issue number12
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

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Endophthalmitis
Amphotericin B
Visual Acuity
Intravitreal Injections
Panophthalmitis
Color
Patient Acuity
Injections
Temazepam
Cataract Extraction
Vitrectomy
Medical Records
Inflammation
Physicians

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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 journalArticle

Payne, JF, Keenum, DG, Sternberg, P, Thliveris, A, Kala, A & Olsen, T 2010, 'Concentrated intravitreal amphotericin B in fungal endophthalmitis', Archives of ophthalmology, vol. 128, no. 12, pp. 1546-1550. https://doi.org/10.1001/archophthalmol.2010.305
Payne, John F. ; Keenum, Deborah G. ; Sternberg, Paul ; Thliveris, Andrew ; Kala, Aaron ; Olsen, Timothy. / Concentrated intravitreal amphotericin B in fungal endophthalmitis. In: Archives of ophthalmology. 2010 ; Vol. 128, No. 12. pp. 1546-1550.
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