Purpose: To report a retrospective case series of patients with chronic post operative endophthalmitis (CPE) after uneventful phacoemulsification (PKE) with intraocular lens (IOL) implantation. Methods: this study was conducted between January 2011 and June 2020, including patients with delayed-onset endopthalmitis occurring at least 2 weeks after uneventful PKE+IOL. Diagnosis was based on typical clinical features associated or not to proven sample culture. Treatment was based on step-by-step management, depending on results of microbiology and response of treatment. It consisted in first line medical treatment with a two-approach intraocular and systemic antiobiotics, followed, if necessary, by a second line conservative-IOL surgical treatment with pars plana vitrectomy (PPV), and a third line non-conservative-IOL surgical treatment with re-PPV associated to IOL explantation. Results: Seven patients were included with a mean age of 62,5 years. Mean duration interval between cataract surgery and diagnosis of CPE was 31,3 weeks. All patients presented a decrease of visual acuity with white intracapsular plaques. Only one patient had positive IOL culture. Medical treatment was sufficient in three cases. In the four other cases, PPV with IOL explantation and total capsular bag removal was conducted. Mean final BCVA was 20/160 with a gain of 4 lines and was ≥ 20/40 in 4 cases. Conclusion: The diagnosis of CPE is still challenging especially for difficulties in isolating microorganisms. It should always be considered in cases of recurrent ocular inflammation resistant to conventional treatment in operated eyes. Non-conservative IOL surgical treatment may be directly necessary in severe cases.

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