Fungal endophthalmitis is a rarer and sight-threateining condition, which is difficult to treat. Standard medication for an acute mycotic infection is amphothericin B, which can be given topically, intravitreally and systemically. This drug carries serious side effects, especially due to its local and systemic toxicity. Voriconazole, a second-generation synthetic fluconazole-derivate (triazole) offers several advantages with respect to the antifungal spectrum, efficacy and safety.


Two case reports illustrate successful ocular and systemic treatment with voriconazole for exogenous and endogenous endophthalmitis, respectively.

Case 1 is an 65-year old male who had an infected scleral buckle after surgery for phakic retinal detachment. Infection had penetrated the sclera with subsequent endophthalmitis. Aspergillus fumigates was the causative strain.

Case 2 is a 30-year old male with bilateral endogenous Candida albicans endophthalmitis.

Both cases were successfully treated with vitrectomy, intravitreal and systemical voriconazole application. To substantiate the treatment concept additional data on bioavailability, pharmakokinetics, the antifungal spectrum and possible toxicity of voriconazole is given.


Voriconazole has a broad antifungal spectrum. Effective therapeutic concentrations in the vitreous cavity can be achieved for most fungus species, esp. Candida and Aspergillus strains. The drug is well tolerated, both for intravitreal and systemical administration. Voriconazole should replace standard therapy with amphothericin B for exogenous and endogenous fungal endophthalmitis.