Evaluation of the choroidal thickness and retinal nerve fiber layer and visual fields in morbid obesity: Does bariatric surgery affect retinal structure and function?

Purpose: The study aimed to investigate the changes in choroidal thickness (CT), retinal nerve fiber layer thickness (RNFL), and visual field parameters in morbidly obese patients following bariatric surgery. Methods: The study included 40 morbidly obese patients with body mass indexes (BMI) ≥40 who had undergone bariatric surgery (Group 1) and 40 age-and sex-matched healthy subjects with normal BMI values (Group 2). RNFL and CT measurements by optical coherence tomography (OCT) and visual field test were performed preoperatively and the 1st, 6th, and 12th months postoperatively. CT measurements were obtained from the subfoveal, nasal (N), and temporal (T) regions at distances of 500 µm and 1,000 µm from the fovea. Results: No significant pathology was detected during ophthalmological examinations following bariatric surgery. The BMIs were found to be significantly lower in all of the periods after bariatric surgery (P < 0.0001). The CT measurements decreased significantly in all periods after bariatric surgery (P < 0.0001). No differences were found in terms of the mean RNFL thicknesses in all postoperative periods (P = 0.125). Visual field tests showed no significant changes during scheduled visits. (P = 0.877). No visual field defect was detected in any patient during the follow-up periods after bariatric surgery. Conclusion: These results have suggested that CT is positively correlated with BMI and decreased with a reduction in BMI progressively. Nutritional disorders resulting from malabsorption have not caused any nutritional optic neuropathy and visual field defect for at least the first postoperative year after bariatric surgery.

Effect of serum cytokines and VEGF levels on diabetic retinopathy and macular thickness.

PURPOSE: To investigate the role of serum inflammatory cytokines and vascular endothelial growth factor (VEGF) in diabetic retinopathy (DR) and evaluate their relationship with macular thickness measurements obtained with optical coherence tomography (OCT). METHODS: The study enrolled 28 healthy subjects (Group 1), 31 patients without DR (Group 2), 49 patients with nonproliferative DR (Group 3), and 46 patients with proliferative DR (Group 4). Macular profile was assessed with Stratus OCT-3 and the serum concentrations of VEGF and interleukin-1 alpha (IL-1 alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), macrophage inflammatory protein (MIP-1 alpha), monocyte chemoattractant protein (MCP-1), and epidermal growth factor (EGF) were measured using multiplex bead immunoassay. RESULTS: The median value of the visual acuity was 20/20 (Groups 1 and 2), and 20/100 (Group 3), and 20/125 (Group 4). The median value of central subfield macular thickness was estimated as 165.50 microm in Group 1, 202.5 microm in Group 2, 318 microm in Group 3, and 310 microm in Group 4. The median serum VEGF level, which was 98.20 pg/ml in Group 1, demonstrated a progressive rise to 125.37 pg/ml in Group 2, to 153.07 pg/ml in Group 3, and to 149.12 pg/ml in Group 4. Statistical significance was found between all groups (p<0.05) except between Groups 3 and 4 (p=0.87). The median levels of IL-1 alpha and IL-6 were zero in all groups. The median serum levels of IL-8, IL-10, MIP-1 alpha, and EGF revealed a wide range within each group but no statistical significance between the groups (p>0.05). The median serum levels of IL-8, IL-10, MIP-1 alpha, and EGF revealed a wide range within each group, however, no statistically significant relationship was found between the groups (p>0.05). The median values of the serum MCP-1 concentrations presented a statistically significant rise with the progression of DR (p=0.02). No correlation was found between macular thickness and serum cytokine and VEGF levels (p>0.05). CONCLUSIONS: Increased serum levels of VEGF and MCP-1 may act as a key regulator of DR and provide a potential tool for risk assessment in diabetic patients. Further studies that evaluate both vitreous and serum levels in various stages of DR are needed to provide a better understanding of the interaction between systemic and local inflammatory and angiogenic factors.

The effect of intravitreal bevacizumab and ranibizumab on macular edema of the contralateral eye: A comparative study of two anti-VEGFs.

PURPOSE: To compare the effects of bevacizumab and ranibizumab on the visual function and macular thickness in the contralateral (untreated) eye of patients with bilateral diabetic macular edema (DME). MATERIALS AND METHODS: Thirty-nine patients with bilateral DME, who had been treated with both bevacizumab and ranibizumab in the same eye, were considered retrospectively for this study. Recorded outcome measurements included the best-corrected visual acuity (BCVA) assessment with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the central subfield macular thickness (CSMT) measurement of the contralateral, uninjected eye before and at 4 weeks after the injections. RESULTS: The median BCVA of the uninjected eye was 50 ETDRS letters and the median CSMT was 459 µm preceding the bevacizumab injection whereas at the control appointment, 4 weeks after the injection, the median BCVA had increased to 52 letters (P = 0.098), and the median CSMT had decreased to 390 µm (P = 0.036). The mean interval between the bevacizumab and ranibizumab treatments was 4.79 ΁ 1.52 months. The measurements of the untreated eye after the ranibizumab treatment showed that the median BCVA decreased from 55 to 52 letters, and the median CSMT increased from 361 µm to 418 µm (P = 0.148 and P = 0.109, respectively). CONCLUSIONS: In contrast to ranibizumab, the intravitreal administration of bevacizumab resulted in a statistically significant decrease in macular thickness in the untreated eye in patients with bilateral DME.

Spectral-Domain Optical Coherence Tomography Findings in Lipemia Retinalis.

Severe hypertriglyceridemia can give rise to a fundus appearance with whitish-colored retinal vessels called lipemia retinalis. A 52-year-old man with hypertriglyceridemia presented with a best-corrected visual acuity of 20/20 in both eyes and creamy-white retinal vessels on fundus. Spectral-domain optical coherence tomography (SD-OCT) revealed hyperreflective and engorged retinal vessels and white dots mainly accumulated in the inner nuclear and ganglion cell layer. Follow-up fundus examination after plasmapheresis sessions revealed normal retinal vessels. The hyperreflective appearance of the retinal vessels in OCT reversed rapidly 5 days after the treatment, whereas hyperreflective dots in retina disappeared slowly in 3 months. OCT is useful in demonstrating inner retinal changes associated with lipemia retinalis at histopathological level. The hyperreflective dots in inner retina associated with leakage from superficial retinal capillaries attested the correlation of their location with their origin. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:589-592.].

Association of Apolipoprotein E Polymorphism with Intravitreal Ranibizumab Treatment Outcomes in Age-Related Macular Degeneration.

PURPOSE: Genetic factors are known to influence the response to anti-vascular endothelial growth factor (VEGF) treatment in exudative age-related macular degeneration (AMD). The current study was conducted to investigate the association of Apolipoprotein E (ApoE) polymorphism with the treatment response to ranibizumab for exudative AMD. METHODS: One hundred nine eyes (109 patients, 59.6% male, mean age 63.84 ± 7.22 years) treated with intravitreal ranibizumab injections were included in the analysis. Smoking status and lesion type were recorded. Patients were categorized into three groups according to visual acuity (VA) change at 6 months after the first injection: VA loss >5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (Group 1); VA change between five ETDRS letters gain and loss (Group 2); VA improvement >5 ETDRS letters (Group 3). The association of ApoE gene polymorphisms with the three groups was evaluated. RESULTS: Both smoking status and lesion type showed no significant association with VA change (p = 0.12 and p = 0.64, respectively). A lower frequency of ɛ2 and a higher frequency of ɛ4 were observed in Group 3 (2.9 and 25.7%, respectively). VA improvement with more than five ETDRS letters was significantly associated with the presence of the ɛ4 genotype (p = 0.01). CONCLUSIONS: This study demonstrated that carriers of the ApoE ɛ4 polymorphism genotype show demonstrable improvement in VA after treatment with ranibizumab in exudative AMD. ApoE polymorphism identification may be used as a genetic screening to tailor individualized therapeutic approach for optimal treatment in neovascular AMD.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole.

Postoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

Strabismus surgery in congenital fibrosis of the extraocular muscles: a paradigm.

BACKGROUND: Congenital fibrosis of extraocular muscles (CFEOM) is a rare group of disorders with variable phenotypes that result from aberrant innervation to the EOMs leading to synergistic vertical and/or horizontal deviations. We report our experience with the surgical management of patients with CFEOM. MATERIALS AND METHODS: We reviewed the clinical findings, the surgical management, and outcomes of 52 consecutive CFEOM patients operated by one surgeon at a university hospital setting between 1993 and 2014. Patients were divided into CFEOM1, 2, or 3 based on clinical and/or molecular genetic findings. RESULTS: Thirty-seven (71.2%) cases were bilateral and 15 (28.8%) were unilateral. Six of the bilateral cases had CFEOM2, and the rest of the patients had either CFEOM1 or CFEOM3. The median age at the first surgery was 10 (1-43) years. Twenty-five were females and 27 were males. Nineteen patients had previous strabismus and/or ptosis surgeries elsewhere. The mean number of operations at our center was 1.6 ± 0.7 (1-4). A temporary stay suture was used in eight patients and permanently in seven. Of the 40 patients with abnormal head position, 18 achieved excellent, 15 good, and seven poor outcomes and ocular alignment in primary position following the latest surgery was excellent in 19, good in 18, and poor in 14 of the patients, as defined in the "Methods" section of the paper. CONCLUSIONS: Although patients with CFEOM present significant strabismus surgical challenges because of EOM dysinnervation, fibrosis, and/or heterotopia, satisfactory alignment and improvement of the head posture can be attained in a significant proportion of patients using an individually tailored surgical approach.

Can intramuscular corticosteroid injection cause nonarteritic anterior ischemic optic neuropathy?

A 56-year-old man noted a sudden decrease of vision in his right eye 4 hours after intramuscular triamcinolone acetonide (TA) injection. A diagnosis of unilateral nonarteritic anterior ischemic optic neuropathy (NAION) was made, and the patient was counseled to discontinue using TA. Examination for possible risk factors revealed controlled hypertension. Final visual acuity was finger counting at 1 m, and the optic disc was pale in his right eye. This is the first reported case of unilateral NAION that has occurred in a patient after intramuscular corticosteroid injection. Although a cause-and-effect relationship is difficult to prove, the short duration between the TA injection and the NAION is noteworthy. The history of corticosteroid injection should be questioned in cases with predisposing conditions such as hypertension.

Comparison of the effect of unilateral intravitreal bevacizumab and ranibizumab injection on diabetic macular edema of the fellow eye.

PURPOSE: To find out whether intravitreally administered bevacizumab and ranibizumab affect the contralateral, untreated, eyes of patients with bilateral diabetic macular edema (DME). METHODS: A retrospective review of patients with bilateral DME, who were treated with intravitreal bevacizumab or ranibizumab, was performed. All enrolled patients received intravitreal 1.25 mg bevacizumab or 0.5 mg ranibizumab in the eye with more severe macular edema. As outcome measures, best-corrected visual acuity (BCVA) was assessed with the Early Treatment Diabetic Retinopathy Study chart and central foveal thickness (CFT) measurement was obtained using optical coherence tomography-3 before and at 2 and 4 weeks after injections. RESULTS: The study included 55 eyes of 55 patients who received bevacizumab (group 1) and 32 eyes of 32 patients who received ranibizumab (group 2). The mean age of the 55 patients [35 female (63.6%), 20 male (36.4%)] in group 1 was 54.31±12.67 years, and the mean age of the 32 patients [20 female (62.5%), 12 male (37.5%)] in group 2 was 56.01±13.29 years. The median BCVA in the uninjected eye showed no statistically significant change at any visit after either bevacizumab or ranibizumab injection (P=0.302, P=0.582, respectively). In group 1, the median CFT in the uninjected eye was 417 µm at baseline; this was reduced to 401 µm at 2 weeks and 372 µm at 4 weeks. The change in CFT was found to be statistically significant (P=0.009). No statistically significant change was found in the median CFT of uninjected eyes of patients treated with ranibizumab (399, 403, and 407 µm before and at 2 and 4 weeks after treatment, respectively). CONCLUSIONS: Compared with ranibizumab, intravitreal administration of bevacizumab resulted in a greater decrease in macular thickness in the untreated eye, in patients with bilateral DME.

Quantitative assessment of anterior chamber inflammation in patients with retained presumed intraocular cotton fiber after phacoemulsification.

PURPOSE: To evaluate anterior chamber inflammation in eyes with retained presumed intraocular cotton fibers after small-incision cataract surgery. METHODS: Fourteen patients with retained presumed intraocular cotton fibers after phacoemulsification were evaluated for anterior chamber inflammation. The control group consisted of 15 patients with no postoperative intraocular cotton fibers. An aqueous flare meter was used to evaluate anterior chamber reaction 1 day, 1 week, and 1 month postoperatively. RESULTS: Retained cotton fibers were detected in the anterior chamber in 6 cases, and in the corneal incision site, extending into the anterior chamber, in 8 cases. The mean flare values at each postoperative visit were statistically similar between two groups. CONCLUSIONS: Following cataract surgery, retained presumed intraocular cotton fibers did not cause any additional inflammation in the eye within the short term. In contrast to other intraocular foreign bodies, which may cause severe inflammation, retained intraocular cotton fibers seem to be well tolerated following cataract surgery.

Comparison of intravitreal bevacizumab and ranibizumab treatment for diabetic macular edema.

AIM: The aim of this study was to compare the effects of bevacizumab and ranibizumab on visual function and macular thickness in patients with diabetic macular edema (DME). METHODS: The data of diabetic patients who had been treated with bevacizumab for DME were reviewed. Those patients who received 1 injection of intravitreal bevacizumab and ranibizumab with at least 6-month interval were considered for enrollment. The best-corrected visual acuity (BCVA) assesment with Early Treatment Diabetic Retinopathy Study (ETDRS) chart and central subfield macular thickness (CSMT) measurement using optical coherence tomography-3 before and after the injections were recorded as outcome measures. RESULTS: The study included 29 eyes of 29 patients with a mean age of 56.18±13.07 years. The median BCVA was 59 ETDRS letters and the median CSMT was 411 µm preceeding the bevacizumab injection. At the 4th-6th week control after the injection, median BCVA increased to 61.50 ETDRS letters and the median CSMT decreased to 373 µm. This change in BCVA and CSMT was found to be statistically significant (P=0.029 and P=0.011, respectively). The mean interval between bevacizumab and ranibizumab treatment was 9.54±2.64 months. Ranibizumab treatment increased the median BCVA from 53 to 66 ETDRS letters and decreased the median CSMT from 428 µm to a level of 279 µm, which were statistically significant (P<0.001 and P<0.001, respectively). The median change in BCVA was 4.5 ETDRS letters in the bevacizumab group and 6 ETDRS letters in the ranibizumab group (P=0.58), whereas the median changes in CSMT were 41 and 100 µm after bevacizumab and ranibizumab injections, respectively (P=0.005). CONCLUSIONS: Bevacizumab and ranibizumab are both effective antivascular endothelial growth factor drugs preferred in the treatment of DME. Our comparison of both therapies on the same patients suggested that the effect on BCVA was not statistically different, but ranibizumab provided more decrease in CSMT.

Topical anesthetic abuse keratopathy: a commonly overlooked health care problem.

PURPOSE: To evaluate the clinical course, treatment modality, factors affecting the epithelization period, and visual outcome in patients with topical anesthetic abuse keratopathy. METHODS: The medical records of 19 patients with a confirmed diagnosis of topical anesthetic abuse keratopathy were retrospectively examined; occupation, initiating event, biomicroscopic findings, treatment modality, epithelization period, and best-corrected visual acuity (BCVA) were noted. The Wilcoxon signed rank test was used to compare BCVA before and after treatment; P values <0.05 were considered statistically significant. RESULTS: In all, 26 eyes in 19 men aged 21-44 (mean age: 31 ± 6) years were included. Initiating events included exposure to arc welding flash (8 patients), metallic foreign body injury (8 patients), and chemical injury (3 patients). On admission to hospital, 10 patients (52.6%) reported that they were using topical anesthetics. Upon admission to the hospital, 10 patients (52.6%) self reported that they were using topical anesthetics. The remaining 9 subjects were discovered to be using topical anaesthetic drops during hospitalization. Twelve patients (63.2%) were found to continue using these agents during their hospitalization. Oval corneal epithelial defect, stromal infiltrate, ring-shaped keratitis, and hypopyon were noted in 100%, 46.2%, 57.7%, and 42.3% of the eyes, respectively. Topical antibiotics (fluoroquinolones or combined fortified cephalosporins and aminoglycosides), preservative-free lubricants/autologous serum, and bandage contact lens/eye patches were used for treatment. Mean epithelization period was 19.96 ± 11.16 days (range: 6-50 days). Mean pretreatment and posttreatment BCVA was 0.12 ± 0.16 (range: 0.001-0.7) and 0.66 ± 0.30 (range: 0.0-1.0), respectively (P < 0.001). CONCLUSIONS: Ophthalmologists should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.

Glucose regulation influences treatment outcome in ranibizumab treatment for diabetic macular edema.

PURPOSE: To evaluate the effect of glucose regulation on intravitreal ranibizumab injection for clinically significant diabetic macular edema (DME). METHODS: This retrospective study enrolled 65 eyes of 65 patients with persistent DME treated with intravitreal ranibizumab injection. The main outcome measures were the change in best corrected visual acuity (BCVA), the central subfield macular thickness (CSMT) recorded with optical coherence tomography (OCT), and its correlation with the serum hemoglobin A(1c) values (HbA(1c)). RESULTS: The study included 24 (36.9%) female and 41 (63.1%) male patients with a mean age of 58.90±9.45 years. The mean HbA(1c) of the enrolled patients was 8.25±1.74% (range 5.7-12.7%). The median value of BCVA at baseline examination was 20/80 (52 letters), and the median CSMT was 468 µm (range 255-964 µm). In the final control after 4-6 weeks following injection, the median value of BCVA increased to 20/50 (59.50 letters) and the median CSMT decreased to 310 µm (range 129-652 µm). This change in BCVA and macular thickness was found to be significant (P<.001 for both). There was no correlation between BCVA and the change in macular thickness (coefficient=0.04, P=.78). The serum HbA(1c) values were found to be negatively correlated with the change in CSMT (coefficient=-0.50, P<.001). CONCLUSIONS: The results of intravitreal ranibizumab injection for DME demonstrated a beneficial effect on visual acuity and a decrease in CSMT which is inversely correlated with the serum HbA(1c) level.

Ocular changes associated with topiramate.

PURPOSE: To determine the changes in refractive error, and the cornea, anterior chamber, and retina induced by topiramate. METHODS: The study included 76 eyes of 38 patients that began to use topiramate due to migraine. Following ophthalmological examination, all of the patients underwent central corneal thickness (CCT), anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement using a Scheimpflug camera, as well as macular thickness, retinal and retinal nerve fiber layer thickness (RNFLT) measurements using optical coherence tomography (OCT). These procedures were repeated 15, 30, and 90 days after the initiation of topiramate therapy. RESULTS: The median refractive error value showed a statistically significant increase from -0.25 diopters (D) to -0.62 D at the 90th day follow-up (P < 0.001). Mean CCT was 570.56 µm before treatment and increased to 573.69 µm at the 15th day follow-up, 575.31 µm at the 30th day follow-up, and 574.56 µm at the 90th day follow-up; however, these changes were not statistically significant. Mean ACV, ACD, and ACA did not exhibit statistically significant changes. Mean retinal thickness (RT) increased during the treatment from 263.46 µm to 271.60 µm, which was not statistically significant. The initial mean RNFLT was 100.56 ± 15.36 µm and significantly increased to 110.2 ± 8.41 µm and 111.03 ± 14.59 µm at the 30th and 90th day follow-ups, respectively (P = 0.01 and P = 0.004, respectively). CONCLUSIONS: During the 3-month follow-up of patients using topiramate 50 mg d(-1) significant myopic shift and an increase in RNFLT were observed. Further studies are warranted in order to assess the effects of topiramate when used long term and at higher doses.

Lumboperitoneal shunt in a patient with Behçet's disease with medically refractory intracranial hypertension.

A 21-year-old male presented with severe throbbing headache, nausea, vomiting and progressive visual loss. Clinical examination revealed bilateral papilledema and left abducens nerve palsy. MRI showed findings consistent with dural sinus thrombosis. Combinging the clinical findings, MRI and a positive pathergy test, the patient was diagnosed with dural sinus thrombosis associated with Behçet's disease (BD). Despite acetazolamide, prednisone, azathioprine and repeated lumbar punctures, his signs and symptoms of intracranial hypertension gradually worsened. Therefore, lumboperitoneal shunting was planned after which rapid resolution of intracranial hypertension was observed. After reviewing similar reports, we suggest that lumboperitoneal shunt placement can be an effective treatment for patients with BD with medically refractory intracranial hypertension associated with dural sinus thrombosis.

Control of steroid-induced glaucoma with surgical excision of sub-Tenon triamcinolone acetonide deposits: a clinical and biochemical approach.

OBJECTIVE: To assess the efficacy of surgical excision of sub-Tenon triamcinolone acetonide (TA) deposits in the control of steroid-induced glaucoma. DESIGN: Prospective, nonrandomized, interventional case series. PARTICIPANTS: Eighteen eyes of 14 subjects with increased IOP within 6 months of sub-Tenon TA injection who did not respond to medical antiglaucomatous treatment were included in the study. METHODS: Under topical anaesthesia, steroid deposits were completely excised and placed in ethyl alcohol for the determination of the TA amount using high-performance liquid chromatography. The patients were followed up for 6 months and a paired-sample t test was used to compare mean IOP before and after excision of sub-Tenon TA deposits. RESULTS: The mean IOP levels before and after the sub-Tenon steroid injections were 15.9 (SD 2.9) mm Hg and 36.4 (SD 8.4) mm Hg, respectively (p < 0.001). IOP levels decreased significantly after the removal of the deposits (mean 15.3 [SD 2.1] mm Hg) (p < 0.001). Within 6 months of follow-up, all glaucoma medications were stopped in 9 subjects without further IOP increase, whereas IOP control in 5 subjects necessitated using glaucoma medications. The median TA amount was found to be 7.35 mg (range 3.3-29.68 mg). IOP decrease after the excision showed no correlation with the amount of TA (p = 0.8). CONCLUSIONS: Surgical excision of the sub-Tenon steroid deposit should be considered as the primary treatment for steroid-induced glaucoma refractory to medical treatment.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole / Endoftalmite fúngica pós-operatória causada por Trichosporon asahii tratada com voriconazol

ABSTRACTPostoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

RESUMOEndoftalmite fúngica pós-operatória é uma complicação rara mas devastadora da cirurgia de catarata. A vitrectomia e injeção intravítrea de anfotericina B, bem como agentes fungicidas sistêmicos, têm sido sugeridos como tratamentos ideais para endoftalmite fúngica. No entanto, esta terapia pode falhar em erradicar as espécies de fungos resistentes aos agentes antifúngicos atuais. Uma dessas espécies de fungos é o fungo saprófita,Trichosporon asahii, que é frequentemente observada, como causa de endoftalmite endógena, em pacientes imunodeprimidos. Relatamos um caso de endoftalmite pós-operatória causada porT. asahii que é resistente a anfotericina B. Ao nosso conhecimento, este é o primeiro relato de endoftalmite porT. asahii tratado com sucesso com voriconazol intravítreo e sistêmico, vitrectomia viapars plana, e remoção da lente intraocular e saco capsular.