Intravitreal voriconazole for the treatment of endogenous endophthalmitis caused by Scedosporium apiospermum

Scedosporium apiospermum is an increasingly recognized cause of endogenous fungal endophthalmitis in immunocompromised patients. The authors describe two patients with endogenous S. apiospermum endophthalmitis treated with intravitreal and systemic voriconazole. Despite a prolonged course of systemic antifungal treatment, both patients subsequently required enucleation for intractable ocular pain due to secondary scleritis. Histological examination of the globes demonstrated the presence of fungal hyphae. Endogenous S. apiospermum endophthalmitis need to be considered in the differential diagnosis of necrotizing retinitis. Despite its efficacy in suppressing disseminated S. apiospermum infection, voriconazole may be ineffective in the treatment of endogenous S. apiospermum endophthalmitis especially if treatment is delayed.