Delayed-Onset Penicillium Species-Associated Bleb-Related Endophthalmitis Following Phacotrabeculectomy with Intraoperative Mitomycin C

Fungal bleb-related endophthalmitis is rare.We report a novel case of delayed-onset bleb-related endophthalmitis caused by Penicillium species.A 74-year-old man who had undergone phacotrabeculectomy with mitomycin C three months earlier for primary open-angle glaucoma presented with left eye redness, pain, and blurry vision for two days.Clinical features of a bleb abscess with hypopyon and vitritis were consistent with the diagnosis of bleb-related endophthalmitis.There was persistent intraocular inflammation despite treatment with topical, systemic, and repeated intravitreal antibiotics.Both aqueous and vitreous cultures subsequently yielded fungal growth after 14 days of incubation.The fungal isolates were reported as Penicillium sp.; however, species-level identification was not available.Targeted antifungal therapy, including topical and intravitreal amphotericin B, together with topical and systemic fluconazole, was initiated.Anterior chamber washout and pars plana vitrectomy with silicone oil tamponade were also performed.Subsequently, the infection resolved, with a final visual acuity of 6/24.Despite being an environmental mold, Penicillium species can be a pathogen in bleb-related endophthalmitis.Clinicians should maintain a high index of suspicion for fungal infection in cases with delayed presentation or poor response to antibacterial therapy.