Favorable Outcome in Coccidioides Endophthalmitis-A Combined Medical and Surgical Treatment Approach

Jennifer J Ling; Derek J Bays; George R Thompson III; Ala Moshiri; Mark J Mannis

doi:10.1097/ICO.0000000000001353

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Favorable Outcome in Coccidioides Endophthalmitis-A Combined Medical and Surgical Treatment Approach

Journal article

Peer reviewed

Favorable Outcome in Coccidioides Endophthalmitis-A Combined Medical and Surgical Treatment Approach

Jennifer J Ling, Derek J Bays, George R Thompson III, Ala Moshiri and Mark J Mannis

Cornea, Vol.36(11), pp.1423-1425

11/2017

DOI: 10.1097/ICO.0000000000001353

PMID: 28872517

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Abstract

To describe a case of Coccidioides endophthalmitis that resulted in a favorable visual outcome after a combined medical and surgical approach. A 33-year-old previously healthy woman was referred for evaluation of dyspnea and left-sided vision loss, which began 3 months before, after a trip to Nevada. She was found to have a pulmonary cavitary lesion and fluffy white material in the anterior chamber. An aqueous and vitreous paracentesis grew Coccidioides species. She was managed medically with a total of 7 weekly intravitreal injections of amphotericin B and intravenous liposomal amphotericin B followed by transition to oral posaconazole. Seven months after presentation, to ensure ocular sterilization and to clear the visual axis, she underwent temporary keratoprosthesis implantation, anterior segment reconstruction, removal of a cyclitic membrane and the crystalline lens, pars plana vitrectomy, placement of a pars plana Ahmed drainage device, and penetrating keratoplasty. After surgical intervention and with maintenance posaconazole therapy, the patient had resolution of her dyspnea and improved uncorrected (aphakic) vision with a clear corneal graft, quiet anterior chamber, and normal optic nerve and retina. A combined medical and surgical approach resulted in a favorable visual outcome and avoided the need for enucleation.

Adult

Amphotericin B - therapeutic use

Antifungal Agents - therapeutic use

Aqueous Humor - microbiology

Coccidioides - isolation & purification

Coccidioidomycosis - drug therapy

Coccidioidomycosis - microbiology

Coccidioidomycosis - surgery

Coccidioidomycosis - therapy

Combined Modality Therapy

Endophthalmitis - drug therapy

Endophthalmitis - microbiology

Endophthalmitis - surgery

Endophthalmitis - therapy

Eye Infections, Fungal - drug therapy

Eye Infections, Fungal - microbiology

Eye Infections, Fungal - surgery

Eye Infections, Fungal - therapy

Female

Humans

Intravitreal Injections

Ophthalmologic Surgical Procedures

Treatment Outcome

Triazoles - therapeutic use

Vitreous Body - microbiology

Details

Title: Subtitle: Favorable Outcome in Coccidioides Endophthalmitis-A Combined Medical and Surgical Treatment Approach
Creators: Jennifer J Ling - University of California, Davis
Derek J Bays - University of California, Davis
George R Thompson III
Ala Moshiri - University of California, Davis
Mark J Mannis - University of California, Davis
Resource Type: Journal article
Publication Details: Cornea, Vol.36(11), pp.1423-1425
DOI: 10.1097/ICO.0000000000001353
PMID: 28872517
ISSN: 0277-3740
eISSN: 1536-4798
Language: English
Date published: 11/2017
Academic Unit: Ophthalmology and Visual Sciences
Record Identifier: 9984182972002771

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