Contrast Study Of Treatments For Aspergillus Endophthalmitis Between Amphotericin B And Amphotericin B Liposome

Objective:In recent years, along with the increasing factors which reduce the immunity functions, the fungal endophthalmitis has presented an increasing trend in the proportion of infectious endophthalmitis. The most common pathogen of fungal endophthalmitis are Candida ,Aspergillus and Fularium. As a kind of severe visually threatening disease, the fungal endophthalmitis has no representative initial symptom and is hard to treat .But the current treatment in fungal endophthalmitis has its inherent disadvantages, could not reach the effective antifungal concentration in the vitreous,which is the main reason why the fungal endopthalmitis healed difficultly. Amphotericin B as the traditional first-line antifungal drug, the side-effect has limited its use. Many clinical doctors paid attentions to the Amphotericin B Liposome, a new form of Amphotericin B,because of its characters of steady effect,better biocompatibility and little side-effect, and carry a new hope to the treatment to the fungal endophthalmitis. In our study, we established animal models of guinea pig, took intravitreal injection with Amphotericin B and Amphotericin B Liposome to observe the different effect between the two kinds of drugs and if the Amphotericin B Liposome has toxicity to the retina.Method:Forty two guinea pigs were divided into seven groups at random,Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ,Ⅶ, and were chosen the right eyes as the trial ones.Eighteen guinea pigs were intravitreal injected Aspergillus suspension(1.0×106 CFU/ml 0.02ml) in groupⅠ,ⅡandⅢ. Twenty four hours after the operation, the six eyes in groupⅡwere intravitreal injected the solution of Amphotericin B of 5μg/0.02ml, and the six eyes in groupⅢwere intravitreal injected the solutions of Amphotericin B liposome of 20μg/0.02ml, with the groupⅠas the empty control group.We observed their different clinical character. The eyes in groupⅣ,Ⅴ,ⅥandⅦeach received 5μg/0.02ml,20μg/0.02ml,40μg/0.02ml and 60μg/0.02ml of intravitreal injected the solutions of Amphotericin B liposome, and to evaluated its retinal toxicity and the safe dose of the intravitreal injection. We detected each eye in seven groups at different time points after operation with slit lamp for four weeks. Retinal functions in groupⅣ,Ⅴ,ⅥandⅦwere evaluated by electroretinography. To evalutae the possible scathe of the structure in the eyes of every group by histology examination at two and four weeks after the operation. Electron microscope was used to evalutae the possible potential damage to the eyes in groupⅣ,Ⅴ,ⅥandⅦ.Result: GroupⅠ,Ⅱ,Ⅲoccurred fungal endophthalmitis in twenty four hours after operation, and their clinical characters were different. The symptom of groupⅠwas the worst in the three groups, especial the inflammation in the anterior chamber and vitreous opacity. The symptom of groupⅡwas lower than groupⅠ,and that of groupⅢwas better than the other two groups. The histopathological exam indicated that the vitreous were soaked by inflammatory cells and the structure of retina were damaged in groupⅠandⅡ,while they were normal in groupⅢ,Ⅳ,Ⅴ,ⅥandⅦ. The result of ERG demonstrated b wave has not depressed in groupⅣandⅤ, and there was no significant statistical difference at different time points between groupⅣandⅤ, but there was significant statistical difference at different time points between groupⅥandⅦ, and there was significant statistical difference at different time points between groupⅣ,Ⅴand groupⅥ,Ⅶ. Electron microscope exam indicated no retinal damage in groupⅣ,Ⅴbut showed retinal damage in groupⅥ,Ⅶ.Conclusion: The safe dose of the intravitreal injection to guinea pig with Amphotericin B Liposome is 20μg.Contrast to Amphotericin B, Amphotericin B Liposome is able to treat Aspergillus endophthalmitis more effectively.