Intravitreal 0.7 mg dexamethasone implant for the treatment of macular edema secondary to endogenous Candida endophthalmitis

Abstract: Our case aims to describe the efficacy and safety of intravitreal 0.7 mg dexamethasone implant (IDI) for the treatment of refractory macular edema (ME) secondary to endogenous Candida endophthalmitis (ECE). A 74-year-old male patient presented for evaluation due to bilateral vision loss and mild ocular redness for 5 days. Three weeks earlier, he had been admitted for nephrolithiasis, complicated by urosepsis. The best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/100 in the left eye. The ophthalmic examination was suggestive of bilateral ECE. The patient underwent bilateral vitrectomy (with polymerase chain reaction positive for Candida albicans in one eye), in association with a 6-week systemic fluconazole therapy, with complete vitreal and chorioretinal response. However, the patient developed ME in his right eye. Over the course of 6 months, the ME was unsuccessfully treated with different medications: dexamethasone 2% drops, prednisolone acetate 1% drops, nepafenac 0.3% drops, dorzolamide 2% drops, oral prednisone, oral acetazolamide, and intravitreal ranibizumab. At that time, we opted for an IDI. One month later, ME disappeared, and BCVA increased to 20/20. This result was maintained throughout the 9-month follow-up. In conclusion, IDI can be considered a safe option for the treatment of ME developing after ECE.