Therapy of endogenous fungal endophthalmitis: miconazole or amphotericin B for coccidioidal and candidal infection.

Three patients with endogenous fungal endophthalmitis were treated intravenously with miconazole. Two patients had disseminated coccidioidomycosis, and one patient had disseminated candidiasis. Intraocular mycotic infections developed in one patient undergoing therapy, and progressed in two others also undergoing therapy. All three patients' ocular infections improved after therapy was switched to intravenous amphotericin B administration. Previous experience with miconazole and amphotericin B therapy for fungal endophthalmitis is reviewed. Whereas several failures have been noted with amphotericin B and success with miconazole, our experience suggests systemic administration of amphotericin B may be superior to systemic administration of miconazole for intraocular mycoses, although further clinical data are urgently needed.