Metastatic carcinoma to the vitreous: an optical coherence tomography and ultrawide field imaging study

scratched the fungal colonies around the incision. The organisms adhered to the tip of the injector nozzle when IOL was inserted, resulting in the intraocular infection. Slit lamp biomicroscopy showed cyclitic membranes around the superior corneal incision linking to the surface of IOL, which correspond to the pathogenic mechanism. Interestingly, the presentation of intraocular inflammation in this case exhibited several clinical features in association with Propionibacterium acnes endophthalmitis. Similar to the acnes infection, the case showed chronic intraocular inflammation with enlarging white plaques within the lens capsular sac and appeared to be the sequestration of the organism. Trichophyton spp. is known to have low metabolic activities and rates of oxygen consumption, and usually need an environment with a weak immune system, a lack of adequate blood circulation and inadequate oxygen in the blood. Therefore, both Trichophyton spp. and Propionibacterium acnes can grow in the capsular bag where oxygen pressure is low. Because the capsule was sealed around IOL, adequate amounts of the antibiotics failed to reach the lens capsular sac. Therefore, the combination of vitrectomy and antifungal agents appears to be the best therapy for fungal endophthalmitis. Thus, in the current case, the intraocular infection recurred just 1 week after the first intravitreal amphotericin B injection. Since the resistant cell walls of fungi enable them to be shielded from antifungal therapy, newer antifungal agents were developed to expand the treatment armamentarium. Voriconazole has excellent oral bioavailability and intraocular penetration. Recent reports have suggested that voriconazole has a broader spectrum of antifungal activity than amphotericin B. In conclusion, we report the first case of post-operative Trichophyton endophthalmitis after cataract surgery. The clinical presentation mimics Propionibacterium acnes endophthalmitis. Early and complete removal of the sequestration in the capsular bag and IOL was essential to eliminate the adherence of the fungal colonies to IOL surface and differential diagnosis. Our patient made a good recovery after a combination of intravitreal amphotericin B injection and systemic voriconazole, but further studies are essential to determine optimal treatments.