Background

Candida albicans chorioretinitis is the most common cause of endogenous fungal endophthalmitis. Echinocandins are recommended as first-line therapy in the treatment of invasive candidiasis (IC), but in clinically stable patients with IC and endophthalmitis caused by Candida species susceptible to azole compounds these are the first-line treatment due to their better intraocular penetration.

Case report

A 42-year-old woman admitted to hospital for duodenal perforation after gastrointestinal surgery and treated with broad-spectrum antibiotics developed C. albicans candidemia. According to protocol, an antifungal treatment with anidulafungin was given. The patient presented no visual symptoms but on routinary ophthalmoscopic examination multiple bilateral chorioretinal lesions were observed. Systemic therapy was changed to fluconazole, with good systemic and ocular results.

Conclusions

Azole compounds are the first-line therapy for endophthalmitis associated with candidemia. However, clinical guidelines often propose echinocandins as the first option for IC. In some cases, C. albicans chorioretinitis will require a change in the systemic treatment to assure better intraocular penetration. According to the current evidence and our own experience, routine funduscopy is not necessary in all IC patients. However, we do recommend fundus examination in patients with visual symptoms or those unable to report them (paediatric patients and patients with an altered level of consciousness), and in those who are being treated with echinocandins in monotherapy.

中文翻译：

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阿尼芬净与氟康唑治疗白色念珠菌脉络膜视网膜炎的比较

背景

白色念珠菌脉络膜视网膜炎是内源性真菌性眼内炎的最常见原因。棘白菌素被推荐作为治疗侵袭性念珠菌病 (IC) 的一线疗法，但在临床稳定的 IC 和由对唑类化合物敏感的念珠菌属引起的眼内炎患者中，由于它们具有更好的眼内渗透性，这些是一线治疗。

案例报告

一名 42 岁女性因胃肠手术后十二指肠穿孔入院并接受广谱抗生素治疗后出现白色念珠菌血症。根据方案，给予阿尼芬净抗真菌治疗。患者没有出现视觉症状，但在常规检眼镜检查中观察到多处双侧脉络膜视网膜病变。全身治疗改为氟康唑，全身及眼部效果良好。

结论

唑类化合物是念珠菌血症相关眼内炎的一线治疗药物。然而，临床指南通常建议将棘白菌素作为 IC 的首选。在某些情况下，白色念珠菌脉络膜视网膜炎需要改变全身治疗以确保更好的眼内渗透。根据目前的证据和我们自己的经验，并非所有 IC 患者都需要进行常规眼底检查。但是，我们建议对有视觉症状或无法报告症状的患者（儿科患者和意识水平改变的患者）以及正在接受棘白菌素单药治疗的患者进行眼底检查。