Intravitreal Caspofungin in the Treatment of Fungal Endophthalmitis


Capsofungin is a recently introduced, synthetic antimycotic drug with excellent efficiency against candida and aspergillus species. For intravenous use less side effects were reported compared to Amphotericin B. In retinal cell cultures and in animal eyes, Capsofungin showed relatively low toxicity. In this case series we used intravitreal Capsofungin to treat two patients with fungal endophthalmitis that were referred to us.


According the published data on dosage from experimental use and the MIC90 of Capsofungin we assumed a safe and potent intravitreal concentration of 6,5µg/ml. Patient 1 suffered from postsurgical Aspergillus endophthalmitis that was resistant to Amophtericin B. The diagnosis of Patient 2 was endogenous Candida albicans endophthalmitis. Both patients were treated with emergency pars plana vitrectomies. At the end of the surgeries, 26µg/0,1ml of Capsofungin were injected into the posterior cavity. Postoperatively, the treatment was continued with i.v. antimycotic drugs. The eye and especially the retina were checked regularly for potential toxic damage.


Both patients had a marked improvement of their condition shortly after vitrectomy and intravitreal injection of Capsofungin. Toxic damages to the retina, e.g. untypical retinal necrosis or vasculitis, were absent. However, in both cases the systemic antimycotic treatment had to be continued for several weeks.


Intravitreal Capsofungin in the applied concentration was a safe and effective alternative to Amphothericin B for the treatment of fungal endophthalmitis.


Burkhard von Jagow
Berlin, Germany
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