CORTICOSTEROID THERAPY: Within 24 hours of the start of a therapeutic trial of prednisolone acetate, 1%, q1h, OS with close follow-up, a 5% hypopyon with 3-4+ cell and flare developed, as well as scattered areas of plaque formation on the PCIOL. Visual acuity was 1/200 OS. Funduscopic examination was unchanged.

VITRECTOMY AND ANTIBIOTIC REGIMEN: Pars plana vitrectomy and intravitreal antibiotic injections, vancomycin (1.0 mg in 0.1 ml) and ceftazidime (2.25 mg in 0.1 ml), were performed without complication. At surgery, 5 clock hours of retained cortical material was removed from the posterior segment between the 4-o’clock and 9-o’clock positions. The posterior hyaloid was excised out to the equator, and residual blood was aspirated from the retinal surface in the area centralis. No areas of retinitis were identified. We used a flexible iris retractors to dilate the pupil widely, and identified an inferotemporal tear in the posterior capsule, but no peripheral cortical fragments were present in the lens bag. The patient was again hospitalized and received cefazolin (1g, IV, q8h) as well as topical fortified vancomycin (50 mg/ml) alternating with ceftazidime (50 mg/ml) every half hour, and prednisolone acetate, 1% drops, q1h.

ORGANISMS: Gram stain showed multiple polymorphonuclear leukocytes, but no organisms grew from the aqueous or vitreous samples.

INPATIENT FOLLOW-UP: The patient was discharged after 5 days, with hand motions vision OS and an anterior segment examination significant for no hypopyon, 1-2+ cell and flare, a well-centered PCIOL, and clear anterior vitreous. The ocular inflammation improved slowly, without evidence of recurrence of the infection. After treatment for cystoid macular edema (documented with fluorescein angiography), the patient’s vision improved to 20/60+ OS, 6 months after the second vitreous surgery.