A Comparative Treatment Study of Intravitreal Voriconazole and Liposomal Amphotericin B in an Aspergillus fumigatus Endophthalmitis Model

Abstract

Purpose: To compare the effects of voriconazole (VCZ) and liposomal amphotericin B (Amp-B) in an experimental model of Aspergillus fumigatus endophthalmitis.

Methods: Thirty guinea pigs received an intravitreal injection of A. fumigatus to induce endophthalmitis. The animals were randomly divided into three groups, including control (0.02 mL balanced salt solution intravitreal injection) and experimental (20 μg VCZ/0.02 mL or 20 μg liposomal Amp-B/0.02 mL intravitreal injection) groups. Corneal opacity, aqueous flare, and vitreous opacity were graded, and electroretinographic examinations were performed at multiple time points. At 28 days post treatment, histopathology was performed to examine the retinal architecture.

Results: The inflammation in the VCZ and liposomal Amp-B groups was milder than that in the control group. Corneal opacity, aqueous flare, and vitreous opacity scores, as well as electroretinographic recording, showed significantly less inflammation in the VCZ group compared with the liposomal Amp-B group during the early and middle stages of endophthalmitis (P < 0.05). Normal histologic structure of the retina was observed in eyes treated with VCZ and liposomal Amp-B.

Conclusions: Both intravitreal VCZ and liposomal Amp-B were effective treatments for A. fumigatus-induced endophthalmitis in guinea pigs. Voriconazole was superior to liposomal Amp-B at doses similar to the initial therapy for acute infections. Further experimental and clinical studies are required to confirm the efficacy of these two antifungal drugs. Chinese Abstract.