Intravitreal Voriconazole: An Electroretinographic and Histopathologic Study | Fungal Infections | JAMA Ophthalmology | JAMA Network
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Laboratory Sciences
November 2004

Intravitreal Voriconazole: An Electroretinographic and Histopathologic Study

Author Affiliations

Author Affiliations: Department of Ophthalmology,Cullen Eye Institute, Baylor College of Medicine, Houston, Tex (Drs Gao, Pennesi,Shah, Hariprasad, Mieler, Wu, and Holz); and the Department of Cellular Biologyand Anatomy, Louisiana State University Health Science Center, Shreveport(Dr Qiao). Dr Mieler is now with the Department of Ophthalmology and VisualScience, University of Chicago, Chicago, Ill.

Arch Ophthalmol. 2004;122(11):1687-1692. doi:10.1001/archopht.122.11.1687

Background  Voriconazole, a novel triazole antifungal agent, presents potent activityagainst a broad spectrum of yeast and molds.

Objective  To determine whether voriconazole could be safely used as an intravitrealagent in the treatment of fungal endophthalmitis.

Methods  Retinal toxicity of voriconazole was examined in a rodent animal model.Voriconazole solutions were serially diluted and injected intravitreally intothe eyes of normal adult Sprague-Dawley rats so that the final intravitrealconcentrations were 5 μg/mL, 10 μg/mL, 25 μg/mL, 50 μg/mL, and500 μg/mL (n = 3 for each concentration group). Saline was injectedinto the fellow eyes of all animals as controls. Three weeks after injections,electroretinograms were measured, and eyes were subsequently enucleated forhistologic examination.

Results  In electroretinographic studies, maximum scotopic b-wave, intensityneeded for half saturation, and saturated a-wave amplitude were measured.There was no statistically significant difference in these parameters recordedbetween control eyes and voriconazole-injected eyes in any concentration groups.Histologic examination with light microscopy did not reveal any retinal abnormalityin the eyes with 5 to 25 μg/mL of intravitreal voriconazole. In the eyeswith 50 μg/mL and 500 μg/mL of voriconazole, small foci of retinal necrosiswere occasionally observed in the outer retina, especially in the eyes with500 μg/mL of voriconazole.

Conclusions  Our results demonstrate that intravitreal voriconazole of up to 25 μg/mL causes no electroretinographic change or histologic abnormality in rat retinas.This indicates that voriconazole is a safe antifungal agent for intravitrealinjection in rodents and may be used in the treatment of human fungal endophthalmitisfollowing further study.