a 58-year - old man was admitted to our opthalmology department with the complaint of decreased visual acuity . best - corrected visual acuity ( bcva ) was 0.2 on snellen 's acuity chart in the right eye , 1.0 in the left eye and bilateral intraocular pressure meaurements were in normal limits . fundus fluorescein angiography revealed non - ischemic brvo and macular edema in the right eye . optical coherance tomography revealed cystoid macular edema with a central retinal thickness of 430 m . the patient underwent intravitreal ranibizumab injection afterwards ; however there was not any improvement in macular edema . as a result , we decided to implant intravitreal sustained - release dexamethasone ( ozurdex ) to the patient with cystoid macular edema because of crvo . the procedure was performed in the operating room adhering strictly to the rules of sterilization . we used a single - use sterile injection set and the instruments were prepared on a sterile tray . a sterile anesthetic drop was placed in the appropriate eye . a periocular scrub using 10% povidone iodine ( pvi ) was performed , and 5% pvi drop was placed on the ocular surface before the injection . a fenestrated self - adhesive surgical drape that covered the patient 's nose and mouth , and a sterile lid speculum two days after the procedure , the patient presented with ocular pain , blurred vision and photophobia . significant anterior chamber reaction with hypopyon , moderate corneal edema and severe vitritis were detected on examination ( fig . b - scan ultrasonography showed vitreous opacification , but no retinal detachment . according to the results described above , a diagnosis of endophthalmitis was made . we subsequently performed emergent 23-gauge pars plana vitrectomy ( ppv ) and the implant was removed from the vitreous cavity using a retinal forceps ( fig . we diagnosed cataract formation one week after the procedure and the blurring in the vitreus was still present . five days after the last procedure , the signs and symptoms of endophthalmitis were resolved with total remission of pain and hypopyon . endophthalmitis is one of the most feared complications of ophthalmic invasive procedures , and appears to be a very rare complication of sustained - release dexamethasone intravitreal implant . ozurdex is a type of intravitreal therapy which is designed to provide sustained delivery of 700 g of preservative - free dexamethasone to the vitreous cavity and retina . ozurdex has been recently approved by the united states food and drug administration for the treatment of macular edema associated with crvo and brvo . several clinical studies revealed favorable results regarding the beneficial effects of ozurdex in the treatment of brvo . in addition , researchers reported limited side effects without any infection or endophthalmitis , but pain , ocular hypertension , anterior chamber cells , cataracts , vitreous hemorrhage , and retinal detachment did occur . despite the attempts to provide aseptic conditions before injection in order to avoid microbial contamination causing acute endophthalmitis , the patient developed complications involving endophthalmitis 2 days after ozurdex implantation . therefore , because of the loss in vision to hand motion , we immediately performed ppv and removed the implant on the same day as the intravitreal antibiotic injection . unlike endophthalmitis after cataract extraction for which specific guidelines were developed by the endophthalmitis vitrectomy study , there is no established treatment protocol for endophthalmitis after intravitreal implantation of ozurdex . although our patient was treated with intravitreal antibiotics and ppv on the same day of presentation , we did not follow a strict treatment protocol for endophthalmitis regarding indications for vitrectomy surgery . similarly , previous reports recommended immediate vitrectomy to reduce the bacterial overload and improve the outcome before the loss of vision according to the prespecified criteria defined by the endophthalmitis vitrectomy study . we think that surgical removal of the implant and immediate ppv is an important step in the management of endophthalmitis . given the increasing number of injections in clinical practice , the overall number of endophthalmitis cases is expected to increase as well . therefore , there seems to be an emerging need to make a consensus statement for endophthalmitis regarding the intravitreal implant procedure . despite the unique characteristics seen in this case report , we are aware of some limitations associated with this case including the culture negativity and the nonmethodical treatment algorithm that we followed . the culture was negative in our case ; therefore we can not exclude the possibilty that noninfectious injection - related inflammation might be mistakenly attributed to infectious endophthalmitis . in cases of identified bacterial strains , however , the issue of empirical treatment with antibiotics covering potential microorganisms should be kept in mind , even if the culture is negative . in conclusion surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases . further studies are needed to establish a treatment algorithm for the treatment of endophthalmitis after sustained - release dexamethasone intravitreal implant .