Penetrating keratoplasty surgery combined with vitrectomy after failing previous corneal surgery

PURPOSE: The preoperative and postoperative factors influencing visual outcome were analyzed in 15 eyes of 15 patients with graft opacity after keratoplasty associated with vitreoretinal disease who underwent combined surgery of fresh corneal retransplantation and vitrectomy. MATERIALS AND METHODS: The data obtained consisted of diagnosis, preoperative visual acuity, corneal and vitreoretinal findings at the time of surgery, interval between the first visit and surgery, intraocular pressure before surgery, gonioscopic findings, results of bacterial culture of surgical specimens, surgical procedure for vitrectomy, corneal and vitreous findings after surgery, visual acuity 6 months after surgery, intraocular pressure after surgery, and additional surgical techniques. RESULTS: The cause of corneal opacity was graft rejection in all patients, who had been treated with high-dose administrations of steroids and cyclosporin. The preoperative diagnosis was proliferative vitreoretinopathy (PVR) in eight eyes and fungal endophthalmitis in seven eyes. Corneal transparency was achieved in 7 eyes (46.6%) 6 months after surgery. Vitreoretinal findings improved in 9 eyes (60%) and PVR recurred in 6 eyes (40%). Visual acuity improved in 7 eyes (46.6%), did not change in 2 eyes (13.3%), and deteriorated in 6 eyes (40%). The six eyes with decreased visual acuity developed phthisis bulbi. Preoperative intraocular pressure was 2.1 mmHg on average in the phthisis bulbi group, significantly lower than in the group with superior prognosis. Goniosynechia was noted before surgery and did not improve after surgery in all six eyes. CONCLUSIONS: The outcome was poor in eyes with goniosynechia and ocular hypotony, and combined surgery is not indicated for either anatomic or visual preservation in such cases. Care should be taken not to overlook intraocular infection in patients undergoing immunosuppressive therapy against graft rejection. The early detection of retinal detachment is also important in eyes exhibiting hypotony after surgery.     

Visual outcome and bacterial sensitivity after methicillin-resistant Staphylococcus aureus-associated acute endophthalmitis

PURPOSE: To determine the frequency, visual outcome, and bacterial sensitivity in cases of methicillin-resistant Staphylococcus aureus (MRSA)-associated acute postoperative endophthalmitis occurring after cataract surgery. DESIGN: Retrospective, consecutive, observational case series. METHODS: Sixty-four cases of acute endophthalmitis occurring within six weeks after cataract surgery were identified over a three-year interval at a single vitreoretinal practice. Cases related to MRSA were studied and visual outcomes and bacterial sensitivities were recorded. RESULTS: Thirty-three of the 64 eyes were culture positive, and six of the 33 cases (18.2%) demonstrated MRSA infection. All six eyes were started on fluoroquinolone antibiotics two or three days before surgery. Corneal abnormalities were noted in five of the six cases (83.3%), ranging from wound infection to diffuse corneal opacification. Visual acuity at last follow-up was no light perception (NLP) in two eyes, hand movements in two eyes, and 20/30 or better in two eyes. One eye with NLP vision underwent enucleation within three days of presentation because of panophthalmitis and impending sepsis. All six organisms were sensitive in vitro to both gentamicin and vancomycin. No organism was sensitive to any fluoroquinolone antibiotic, although not all organisms were tested against all fluoroquinolones. CONCLUSIONS: MRSA infection accounts for 18% of culture-positive cases of endophthalmitis in this study and was associated with a poor visual outcome in two-thirds of our patients. MRSA organisms may be resistant in vitro to all generations of fluoroquinolone antibiotics, but do seem to be sensitive to gentamicin and vancomycin. The incidence of MRSA endophthalmitis seems to have increased significantly since the Endophthalmitis Vitrectomy Study was published in 1996.     

白内障术后急性感染性眼内炎的临床特征

目的　探讨天津医科大学眼科医院白内障手术后急性感染性眼内炎的临床特征。方法　回顾性分析2007年12月至2017年12月在我院行白内障手术后发生急性感染性眼内炎患者的临床资料,共有28例（28眼）发生眼内炎。统计患者性别、年龄、发病率、白内障术后眼内炎的发病时间、病原体种类、治疗方式、出院时患者的视力及基础疾病的情况。结果　我院近十年有28例28眼发生白内障术后急性感染性眼内炎,发病率为0.041％,其中男10例10眼,发病率为0.015％,女18例18眼,发病率为0.026％;患者的年龄为25～84（66.11±13.80）岁;发生白内障术后急性感染性眼内炎的时间为（8.39±6.92）d;怀疑患有眼内炎并首次检查患者时,角膜水肿的发病率为64.3％（18/28）,前房积脓的发病率为42.9％（12/28）;17眼在确诊后行玻璃体切割术联合玻璃体内注药,11眼只接受了前房和（或）玻璃体内注药;治疗后患者的视力为(0.90±0.86）logMAR;患者病原体培养的阳性率为64.3％,其中表皮葡萄球菌10眼,约占35.7％。结论　白内障术后急性感染性眼内炎的发生受多种因素的影响;感染的致病菌以凝固酶阴性的表皮葡萄球菌为主;患者视力的恢复和初次检查时临床表现的严重程度相关;确诊后及时行玻璃体切割术可以提高患者的最终视力。     

Recurrent Enterococcus faecalis endophthalmitis after phacoemulsification

We present the first reported case of late recurrence of postoperative Enterococcus faecalis endophthalmitis after cataract surgery in a 45-year-old diabetic man. Culture-positive E faecalis endophthalmitis was diagnosed 2 days after uneventful phacoemulsification. Early vitrectomy with intravitreal and subconjunctival vancomycin and amikacin and topical vancomycin resulted in apparently complete clinical resolution after 4 months and a best corrected visual acuity of 20/25. Recurrent endophthalmitis with hypopyon occurred 7 months postoperatively and resolved with intravitreal vancomycin and topical prednisolone acetate 1%. However, the patient had a similar relapse at 9 months that resulted in deterioration of visual acuity to no light perception despite a repeat vitrectomy, intraocular lens explantation, capsular bag removal, and intravitreal antibiotics. The late recurrences could have been the result of persistent sequestration of the organism in the capsular bag.     

Vitrectomy for the treatment of expulsive hemorrhage

PURPOSE: To evaluate the surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery. METHODS: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months. RESULTS: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or belter in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital. CONCLUSION: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.     

白内障术后急性眼内炎

目的 :探讨白内障术后急性眼内炎的临床特点及治疗方法。方法 :回顾性分析 4例 (5眼 )白内障术后急性眼内炎的治疗经过及病原学特点。结果 :5眼白内障术后急性眼内炎经玻璃体切割术及玻璃体腔注药后 ,并辅以全身及局部抗菌素治疗 ,眼内炎症得到控制 ,5眼最后视力得到不同程度改善 ,细菌培养为表皮萄葡球菌 3眼 ,金黄色萄葡球菌 1眼 ,施氏假单胞菌 1眼 ,这些细菌均对万古霉素、妥布霉素、庆大霉素及头孢他定 (复达欣 )敏感。结论 :白内障术后眼内炎是白内障手术的严重并发症 ,玻璃体切割术联合玻璃体腔内注药是一种有效的治疗方法。     

Intravitreal triamcinolone acetonide as an additional tool in pars plana vitrectomy for proliferative diabetic retinopathy

PURPOSE: To evaluate the safety and efficacy of intravitreal injections of crystalline triamcinolone acetonide as an adjunctive procedure in pars plana vitrectomy for proliferative diabetic retinopathy. METHODS: This nonrandomized comparative study included 30 patients (32 eyes) who underwent standardized pars plana vitrectomy for treatment of proliferative diabetic retinopathy and who received an intravitreal injection of 25 mg triamcinolone acetonide at the end of surgery. Mean follow-up time was 5.60 +/- 5.14 months. The study group was compared with a control group (32 eyes) matched with the study group for preoperative and intraoperative parameters and who underwent pars plana vitrectomy for proliferative diabetic retinopathy without intravitreal injection of triamcinolone acetonide. RESULTS: The study group and the control group did not vary significantly in frequency of postoperative retinal detachment, re-pars plana vitrectomy, or postoperative enucleation or phthisis bulbi, or in best postoperative visual acuity, visual acuity at end of the study, or gain in visual acuity. CONCLUSIONS: In this pilot study, the study group with pars plana vitrectomy and intravitreal triamcinolone acetonide injection compared with the nonrandomized control group without intravitreal triamcinolone acetonide injection did not show a higher than usual rate of postoperative complications. As a corollary, however, the data do not suggest the adjunct use of 25 mg intravitreal triamcinolone acetonide combined with pars plana vitrectomy as treatment of proliferative diabetic retinopathy.     

Vitrectomy for the Treatment of Expulsive Hemorrhage

Purpose: An evaluation of surgical outcome of vitrectomy in the treatment of expulsive hemorrhage associated with intraocular surgery.Methods: We reviewed 12 eyes from 12 patients with expulsive hemorrhage, occurring after or during cataract extraction (4 eyes), phacoemulsification (2 eyes), glaucoma filtering surgery (4 eyes), or vitrectomy (2 eyes). Mean follow-up period was 21 months.Results: The retina was reattached in 6 eyes (50%) after the initial surgery and ultimately in 9 eyes (75%). Three eyes, which failed to achieve retinal reattachment, resulted in phthisis bulbi. Final visual acuity was 0.1 or better in 4 eyes and 0.01 to 0.09 in 4 eyes. The incidence of expulsive hemorrhage was 0% for cataract surgery, 0.57% for trabeculectomy, and 0.09% for vitrectomy at Toho University Sakura Hospital.Conclusion: In the treatment of expulsive hemorrhage, vitrectomy is an effective surgical procedure to improve the visual function.     

Clinical Analysis of Cataract Surgery Complicated by Endophthalmitis

Purpose:.To assess the efficacy of vitrectomy combined with intravitreal injection in the treatment of endophthalmitis after phacoemulsification and IOL implantation. Methods:.Five patients.(5 eyes),.who had undergone conventional phacoemulsification combined with IOL implantation at another treatment facility,.presented with endophthalmitis. The subjects ranged in age from 41 to 79 years (65.8±0.5 years on average),.and three were male..All five cases received bacterial culture susceptibility testing..On the basis of the treatment of primary disease, 3 cases had anterior chamber irrigation,.and posterior vitrectomy followed by intravitreal injection of 1 mg vancomycin plus 2.25 mg ceftazidime. Results:.Four out of the five cases of endophthalmitis had a positive bacterial culture testing results.(two cases of staphylococcus epidermidis,.one case of enterococcus faecalis and one case of head-like staphylococcus),.and the remaining case had no bacterial growth..Four cases showed restored visual acuity,.clear vitreous cavity,.and no retinal detachment or other complications. Conclusion: Management of patients presenting with endophthalmitis subsequent to cataract surgery should include: prompt bacterial culture and drug sensitivity tests, and where appropriate, vitrectomy combined with intravitreal injection of vancomycin.     

Endophthalmitis Caused by Citrobacter Species

Purpose: To investigate clinical settings, treatments, antibiotic sensitivities, and visual outcomes associated with endophthalmitis caused by Citrobacter species. Methods: Data were collected for organisms, surgical intervention, antibiotic sensitivity patterns, and final visual acuity. Results: Six eyes of 6 patients with culture-proven C. freundii (n = 4) or C. koseri(n = 2) endophthalmitis were identified. Clinical settings included cataract surgery (1 eye), cataract surgery combined with trabeculectomy (1), trauma (2), penetrating keratoplasty (1), and presumably endogenous source (1). Primary or secondary evisceration was performed in 3 eyes. Initial pars plana vitrectomy with intravitreal antibiotics was performed in 3 eyes. Final visual acuity was no light perception in 5 eyes, and 1 patient with traumatic C. koseri endophthalmitis achieved a final vision of 20/30. Conclusion: Despite treatment with appropriate antibiotics, Citrobacter endophthalmitis can be associated with a poor visual outcome. Early detection and management may improve the final visual outcome and prevent the possibility of evisceration.     

Endophthalmitis caused by staphylococcus epidermidis: in vitro antibiotic susceptibilities and clinical outcomes.

BACKGROUND AND OBJECTIVE: To investigate the antibiotic sensitivities and clinical outcomes of eyes with endophthalmitis caused by methicillin-sensitive versus methicillin-resistant Staphylococcus epidermidis (MSSE/MRSE). PATIENTS AND METHODS: A retrospective, consecutive case series of all patients with endophthalmitis caused by S. epidermidis from January 1, 1996, through July 1, 2004, was conducted. The antibiotic sensitivities and clinical outcomes were obtained from the corresponding medical records. RESULTS: The study included 86 eyes of 86 patients with S. epidermidis endophthalmitis (34 MSSE and 52 MRSE). Endophthalmitis categories included cataract surgery (58), glaucoma surgery (12), trauma (7), vitrectomy (4), penetrating keratoplasty (4), and corneal suture ulcer (1). In vitro testing revealed that all MSSE and MRSE isolates were sensitive to vancomycin, 67% of MSSE isolates and 67% of MRSE isolates were sensitive to gatifloxacin, and 73% of MSSE isolates and 67% of MRSE isolates were sensitive to moxifloxacin (overall 68% sensitive). All eyes were treated with intravitreal vancomycin and either ceftazidime or amikacin. Visual acuity improved to a median of 20/80 at 3 months and 20/60 at 1 year. I CONCLUSIONS: In the current study, all MSSE and MRSE isolates were sensitive to vancomycin and 68% were sensitive to the fourth-generation fluoroquinolones. There were no significant differences in visual acuity outcomes of endophthalmitis caused by MSSE versus MRSE isolates.     

白内障术后眼内炎的治疗分析

目的：探讨白内障术后眼内炎的治疗方案及效果。方法：对我院2006-01/2010-12白内障摘除术＋人工晶状体植入术的21973例28722眼患者的资料（超声乳化20937例27521眼,囊外摘除术1036例1201眼）进行回顾性分析。结果：在全部术眼中,感染性眼内炎11眼,感染率为0.04%,9眼发生于超声乳化术后,2眼发生于白内障囊外摘除术后。共有5眼病原菌培养阳性,其中表皮葡萄球菌2眼,金黄色葡萄球菌,浅绿色气球菌,真菌各1眼。感染发生于白内障术后2wk以内者占73%（8/11）,房水混浊或前房积脓者行前房灌洗＋玻璃体腔注射万古霉素;前房积脓合并明显玻璃体混浊或经前房灌洗＋玻璃体腔注射万古霉素治疗观察1～2d感染加重者行前房灌洗＋玻璃体切割术。治疗后11眼均保住眼球。结论：白内障术后眼内炎经常发生于白内障术后2wk以内,经及时有效的治疗可控制感染发展,保留部分有用视力;前房灌洗＋玻璃体腔注射万古霉素必要时联合玻璃体切割术是有效的治疗方法。     

Vitrectomy for the treatment of posttraumatic endophthalmitis

AIM: To evaluate the efficacy of vitrectomy in combination with intravitreal dexamethasone and vancomycin perfusion in the management of severe posttraumatic endophthalmitis. · METHODS: Thirty eyes of 30 cases diagnosed as posttraumatic infectious endophthalmitis were analyzed retrospectively from April 2004 to April 2006. All the patients underwent vitrectomy in combination with intravitreal drugs perfusion and were followed up for 12 to 24 weeks. The visual acuity, traumatic causes and microorganisms culture were analyzed. · RESULTS: There are significant reduction in inflammation at 3 months after surgery. Infectious symptoms were completely controlled in 97% of the cases(29/30). Final visual acuity were improved in 93% of cases (28/30). Among traumatic causes, foreign body is the most common cause (57%). Staphylococcus aureus is the commonest microorganism. · CONCLUSION: Vitrectomy in combination with intravitreal dexamethasone and vancomycin perfusion is the most effective method in the treatment of severe posttraumatic endophthalmitis.     

Clinical features, management strategies, and visual acuity outcomes of Candida endophthalmitis following cataract surgery.

BACKGROUND AND OBJECTIVE: To report the clinical features, management, and visual outcome in patients with Candida endophthalmitis following cataract surgery. PATIENTS AND METHODS: The Bascom Palmer Eye Institute Microbiology Laboratory database and corresponding medical records were reviewed from 1980 to 2006. RESULTS: Five patients were identified. Endophthalmitis developed 7 to 60 days postoperatively (median, 14 days). Presenting visual acuity was 20/200 to counting fingers and final visual acuity was 20/25 to light perception. Whitish material was noted on the intraocular lens or lens capsule (4 of 5) or within the cataract wound (1 of 5). All patients received intravitreal amphotericin B and more than one pars plana vitrectomy procedure; four received systemic antifungal agents and four underwent intraocular lens removal. CONCLUSIONS: Given whitish material on the intraocular lens, lens capsule, or cataract wound, Candida should be included in the differential diagnosis of early- or delayed-onset endophthalmitis following cataract surgery. Initial pars plana vitrectomy and intravitreal and oral antifungal medications may not achieve infection resolution. Intraocular lens explantation may assist in organism eradication.     

The results of pars plana vitrectomy and silicone oil tamponade for endophthalmitis after intravitreal injections

To report the role of early vitrectomy and silicone oil tamponade in acute endophthalmitis following intravitreal injection. Medical records of eight patients who presented with acute endophthalmitis after intravitreal injection of different drugs were retrospectively reviewed. Initial treatment consisted of vitreous tap with cultures and injection of intravitreal antibiotics, with the patients subsequently undergoing pars plana vitrectomy and silicone oil tamponade within 24 h following initial vitreous tap. The mean time to presentation was 1.7 days (1–3 days). The initial best-corrected visual acuity was hand motion to 0.05 before treatment and 0.05–0.8 (Snellen) after treatment. Vitreous cultures were obtained from all patients, of which four were culture positive. Endophthalmitis was controlled in all patients. There was no retinal detachment or phthisis bulbi during the follow-up period (1–4 years). Acute endophthalmitis following intravitreal injection occurs rapidly and requires urgent treatment. If intravitreal antibiotics fail to control inflammation, early pars plana vitrectomy and silicone oil tamponade would be an appropriate option.     

曲安奈德在儿童眼内炎玻璃体切割手术中的应用

目的评价曲安奈德（TA）在儿童眼内炎玻璃体切割手术中的应用及疗效。方法回顾性分析2003年1月-2008年2月在厦门大学附属厦门眼科中心行巩膜外环扎术＋玻璃体切割＋TA注射联合硅油填充术的54例56眼儿童眼内炎患者的临床资料,并根据手术中是否玻璃体腔注射TA分为2组：A组29例29眼;B组25例27眼。术后随访（24．3±12．2）个月,按照患者视力改善情况和视网膜复位情况评估手术效果,并根据术后并发症的情况评价TA在玻璃体切割手术中应用的安全性。结果54例56眼患者出院时眼内炎症均得到控制,脱离的视网膜均解剖复位。除3眼视力检查不合作外,术后视力提高42眼,其中A组26眼（26／29,占89．66％）,B组16眼（16／27,占59．26％）,2组比较差异有统计学意义（χ^2=6．890,P=0．009）。37眼术后矫正视力〉0．05,其中A组23眼（23／29,占79．31％）;B组14眼（14／27,占51．85％）,2组比较差异有统计学意义（χ^2=4．703,P=0．030）。14眼患者玻璃体切割术后继发视网膜脱离,其中A组4例4眼,发生率为13．79％,／3组9例10眼,发生率为37．04％,2组比较差异有统计学意义（χ^2=4．029,P=0．045）。结论儿童眼内炎玻璃体切割手术过程中应用TA可明显改善患者的视力预后,有效预防玻璃体切割手术后视网膜脱离等并发症的发生,提高了手术的安全性和成功率。     

Clinical features of endophthalmitis after cataract surgery evaluated by the presence of background factors

PURPOSE: The clinical features and visual prognosis after vitrectomy for endophthalmitis which had developed after cataract surgery were compared in two groups with or without background factors, including malignant tumor, diabetes, oral steroid administration, collagen disease, dacryocystitis, and lid closure disturbance. METHOD: Fifty-two patients (53 eyes) who underwent a vitrectomy for the treatment of endophthalmitis which had developed within 6 weeks after cataract surgery. They were divided into two groups according to the presence (21 eyes, group A) or absence (32 eyes, group B) of background factors, and were retrospectively compared based on their medical records. RESULTS: The culture-positive rate was 62% in group A and 69% in group B. The incidence of a final visual acuity of more than 20/20 was significantly lower in group A (14%) than in group B (47%, p < 0.05). Methicillin-resistant Staphylococcus aureus, alpha-hemolytic Streptococcus and Enterococcus were frequently identified in group A. Leakage from the cataract wound was found in about 80% of the patients with corneal incisions, and a wound that had not been covered by the conjunctiva was significantly more frequent as a factor in group A (group A, 13 eyes; group B, 10 eyes; p < 0.05). CONCLUSION: Postoperative endophthalmitis may have a less favorable visual prognosis in patients with background factors, so precise wound construction during cataract surgery is important in these patients.     

玻璃体切割术治疗外伤性眼内炎

目的:评价玻璃体切割联合眼内药物灌注治疗严重的外伤性眼内炎的临床效果.方法:回顾性分析30例(30眼)因外伤性眼内炎行玻璃体切除术,术中联合药物玻璃体腔灌注的患者.结果:术后 3mo 29 眼炎症得到控制,眼球得以保留,28眼视力有不同程度提高.眼内异物是最常见的受伤原因,金黄色葡萄球菌是最常见的细菌.结论:及时行玻璃体切割术联合眼内药物灌注是治疗外伤性眼内炎的有效方法.     

Endophthalmitis caused by Pseudomonas aeruginosa

OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.     

Management of retained intravitreal lens fragments after phacoemulsification surgery

PURPOSE: To evaluate the clinical features of eyes with retained intravitreal lens fragments after phacoemulsification surgery and to assess the guidelines of management and the visual outcome after vitrectomy. METHODS: Twenty-five consecutive patients referred to our institute for retained intravitreal lens fragments after phacoemulsification cataract surgery were evaluated retrospectively over a 7-year period. RESULTS: The clinical features of retained lens fragments included deceased visual acuity of 6/60 or worse (68%), uveitis (60%), glaucoma (48%), corneal edema (44%) and retinal detachment in 2 patients (8%). There were 24 patients who underwent pars plana vitrectomy; 1 patient was managed with medical therapy. After vitrectomy, 17 eyes (71%) showed visual improvement, and final visual acuity was 6/12 or better in 13 eyes (54%). The causes of poor final visual outcome of 6/60 or worse included retinal detachment and cystoid macular edema. The time interval between vitrectomy and phacoemulsification was within 4 weeks in 17 patients (71%), ranging from on the same day to 97 days. There was only a trend of better visual outcome in early vitrectomy patients (within 1 week). There was no statistical difference between the initial intraocular lens status and final visual acuity. CONCLUSION: Vitectomy with removal of retained intravitreal lens fragments is beneficial for patients with persistent uveitis and glaucoma after phacoemulsification. In the majority of patients, visual improvement was achieved after vitrectomy. However, poor visual outcome may occur secondary to retinal detachment and cystoid macular edema.