Subretinal Injection of Amphotericin B Using a 41‑gauge Needle for Refractory Candida albicans Subretinal Abscess: A Case Report and Literature Review
This case report demonstrates that subretinal injection of amphotericin B using a 41-gauge needle during pars plana vitrectomy successfully controlled a refractory Candida albicans subretinal abscess in an immunosuppressed patient who failed conventional systemic and intravitreal antifungal therapies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Inside the human eye, a delicate layer of tissue called the retina acts as the screen where light is captured to form images. Behind this screen lies a space that is normally empty, but when infection takes hold there, it can create a pocket of pus known as an abscess. This is a rare and dangerous complication of a condition where fungi travel through the bloodstream to the eye, a scenario that often strikes people with weakened immune systems. For decades, doctors have faced a difficult choice when treating these deep-seated infections: use powerful medications that struggle to penetrate the eye's natural barriers, or perform invasive surgery that carries a high risk of tearing the retina and causing permanent blindness. The challenge has been finding a way to deliver medicine directly to the infection without damaging the fragile tissue surrounding it.
A team of researchers at Hangzhou First People's Hospital recently documented a case where they solved this problem for a patient suffering from a stubborn fungal infection. The patient was a seventy-year-old man with a history of diabetes and long-term use of steroids for a joint condition, which had left his immune system unable to fight off a yeast infection called Candida albicans. While the infection had been detected in his urine, it had also traveled to his eyes, causing severe inflammation in both. In his left eye, the infection had formed a large, yellow-white abscess under the retina, measuring four to five times the size of the optic nerve head. Despite repeated injections of antifungal medicine into the center of the eye and strong oral medication, the infection in the left eye continued to grow, threatening to destroy the organ entirely.
Faced with a failing eye, the surgeons decided to try a different approach during a procedure to remove the vitreous gel from inside the eye. Instead of making a large cut in the retina to drain the abscess, which could have caused the eye to detach, they used an ultra-fine needle, so thin it is measured at forty-one gauge. This needle is so small that it creates a self-sealing hole in the tissue. Through this tiny opening, the team injected a concentrated dose of amphotericin B, a potent antifungal drug, directly into the pocket of infection under the retina. This method allowed the medicine to reach the core of the abscess at a level that previous treatments could not achieve.
The result was immediate and effective. Following the injection, the abscess stopped growing and began to shrink, while the surrounding inflammation slowly cleared. The surgeons filled the eye with silicone oil to keep the retina in place and support healing. Over the next few months, the eye remained stable, and the infection was brought under control. Although the patient unfortunately passed away later from a widespread systemic infection unrelated to his eye, the eye itself was saved from removal. The infection did not return, and the patient retained some vision, proving that this precise, minimally invasive technique can succeed where standard treatments fail. This case suggests that for deep fungal infections that refuse to respond to other therapies, delivering medicine directly to the site with a needle this fine offers a safe and powerful new option for saving sight.
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