To report a case of a drug-resistant Penicillium endophthalmitis that was treated with intravitreal voriconazole injection.

A 73-year-old male who developed endophthalmitis after cataract surgery was treated with intravitreal vancomycin and ceftazidime injection after aqueous and vitreous cultures were done. The condition were not improve after intravitreal injection, and the culture showed Penicillium species. Fungal endophthalmitis was diagnosed and pars plana vitrectomy, intraocular lens removal, and intravitreal amphotericin B injection were performed. However, a progressive worsening of the ocular condition was observed, and the patient was transferred to our hospital. At initial visit, the best corrected visual activity was hand movement. The hypopyon and thick exudative membrane filled the anterior chamber. Pars plana vitrectomy and intravitreal voriconazole injection were performed under the diagnosis of drug-resistant Penicillium endophthalmitis. The condition improved after the operation, and there was no recurrence of endophthalmitis until four months after vitrectomy.

Voriconazole is useful in the treatment of drug-resistant fungal endophthalmitis.