Exophiala werneckii endophthalmitis following cataract surgery in an immunocompetent individual

A case of infectious endophthalmitis caused by the saprophyte Exophiala wer neckii is reported. This has not been recognized as a pathogen for ocular i nfections previously. The infection followed uncomplicated cataract surgery involving phacoemulsification and IOL implant. Clinical presentation was t hat of an indolent endophthalmitis with relatively acute onset. Pars plana vitrectomy, fungal stains, and culture established the diagnosis. Initial m anagement consisted of empirical intravitreal injection of vancomycin, ceft azidime, and amphotericin B, Treatment was supplemented with a S-week cours e of systemic fluconazole and topical therapy with natamycin, atropine, cip rofloxacin, and diclofenac, The visual acuity returned to 20/20-2 with no r ecurrence of infection. The source of the infection could not be determined . Fungal endophthalmitis has to be considered as a rare, though important, complication following ophthalmic surgery. Specific fungal stains and cultu res are helpful for establishing the diagnosis early in the course of disea se. E werneckii should be considered in the differential diagnosis of funga l endophthalmitis.