Successful treatment of Paecilomyces lilacinus endophthalmitis following cataract extraction with intraocular lens implantation.

We report a case of mycotic endophthalmitis caused by Paecilomyces lilacinus after cataract surgery. Treatment consisted of early vitrectomy, multiple intravitreal injections of amphotericin B and miconazole, intravenous miconazole and, later, oral ketoconazole. The intraocular lens, which initially appeared uninvolved, was removed six weeks after initiation of therapy and found to contain causative organisms. Final visual acuity was 20/20. We recommend aggressive therapy consisting of early vitrectomy, intravitreal injections repeated as necessary, removal of the intraocular lens, avoidance of intraocular steroid, and administration of systemic antifungal agents.