Douglas J. Rhee, MD

Notes: 1. Keratitis 1 : Topical amphotericin B drops Q1/2–1 hr. with either oral voriconazole, fluconazole , ketoconazole , or itraconazole .If no improvement consider PKP. Some advocate addition of flucytosine drops Q1/2–1 hr 4 or voriconazole Q1 hr.2. Choroiditis 3 : If isolated choroiditis, then use amphotericin B 0.5–0.8 mg/kg/day with flucytosine 2 gm PO Q6 hr ×8–10 weeks 5 ; if unresponsive or endophthalmitis/significant vitritis develops, may use intravitreal amphotericin B withvitrectomy. 6(2) Molds(a) Aspergillosis (Aspergillus ) (Filamentous Fungus, Septate Hyphae) 3Notes: 1. Dacryocystitis: Surgical removal of ‘aspergilloma’ with possible surgical reconstruction of nasolacrimal drainage system isthe definitive treatment. Antifungal medication is not generally required.2. Keratitis 1 : First choice is topical amphotericin B drops Q1 hr initially with oral voriconazole, ketoconazole or fluconazole ;Second choice topical agent is voriconazole or natamycin. Consider miconazole drops for infections refractory to amphotericinB, voriconazole, and natamycin.3. Endophthalmitis 3 : Intravitreal and subconjunctival amphotericin B with vitrectomy. Should evaluate for systemicinvolvement.4. Orbital infection 3 : Requires surgical debridement with intravenous amphotericin B.(b) Fusarium (Filamentous Fungus, Septate Hyphae)Notes: 1. Keratitis 1 : First choice topical agent is natamycin every 30 min to 1 hr for first two days ; second line topical agents arevoriconazole, miconazole, or flucytosine .Antifungal Agents 37