Editor, In 1993, Staar Surgical AG introduced a modified phakic posterior chamber intraocular lens (PPC IOL), the implantable contact lens (ICL), for the correction of high myopia. The concept of PPC IOL suggests advantages over previous surgical methods used to correct moderate to high myopia. Refractive corrections up to −21 diopters (D) are possible, accommodation is preserved, and implantation is safe and potentially reversible (Lackner et al. 2004). However, the potential for vision-threatening complications following the implantation of PPC IOL is a possibility that has become apparent in our recent findings. We report the clinical and microbiologic findings of a case of infectious endophthalmitis caused by Pseudomonas aeruginosa in a 23-year-old woman after implantation of PPC IOL to correct high myopia. The patient was referred to our hospital for severe pain and decreased visual acuity in her left eye. She developed an uncomfortable, painful left eye 1 month after the PPC IOL implantation of both eyes. The IOL in her left eye was exchanged 1 week after the first surgery as a result of increased intraocular pressure (IOP) combined with a poorly sized IOL. She had received no systemic, periocular or intraocular antibiotic drugs preoperatively and had no previous history of systemic or ocular diseases. On examination, visual acuity was 20/20 in the right eye with light perception in the left eye. Biomicroscopy of the left eye showed a red eye, mild corneal oedema, a deep anterior chamber with cells and flare and severe vitritis (Fig. 1), which were thought to represent infectious endophthalmitis. The fellow eye was normal with a well-positioned PPC IOL. A slit-lamp photograph of the left eye shows a red eye, mild corneal oedema, a deep anterior chamber with cells and flare, and severe vitritis. Immediate management involved obtaining anterior chamber and vitreous aspirates for culture and gram stain. After the removal of the PPC IOL, the patient had a pars plana vitrectomy with a lensectomy remaining anterior capsule and an intravitreal antibiotic injection (ceftazidime and vancomycin). The patient was also treated with systemic (cetrazidime 1 g IV 12 hr) and topical (fortified cefrazidime and vancomycin hourly) antibiotics, and dexamethasone 0.1% and cyclopentolate 1% eye drops four times a day. The gram stain smears revealed no bacteria, and the cultures were positive for P. aeruginosa, which was sensitive to all antibiotics used. Systemic antibiotic treatment was continued for 1 week, and the topical treatment was tapered gradually over 3 months. Slit-lamp examination of the left eye showed a quiet eye 6 months after vitrectomy. Then, a secondary IOL implantation in the sulcus was performed, and no complications or recurrences were found through 8 months after the operation, with the best corrected visual acuity of 20/30. Infectious endophthalmitis is one of the most vision-threatening complications after intraocular surgery. The crude rate of endophthalmitis after PPC IOL implantation has been reported as approximately 0.0167% (Allan et al. 2009). To our knowledge, no previous case of endophthalmitis caused by P. aeruginosa related to PPC IOL implantation for correcting high myopia has been reported. P. aeruginosa is a gram-negative rod, and it may cause endophthalmitis (O’Brien & Hazlett 1996). Our patient developed endophthalmitis 1 month after the first implantation and 3 weeks after the exchange of a PPC IOL. The median interval between surgery and presentation of endophthalmitis caused by P. aeruginosa was reported as 4 days with a range from 1 to 26 days (Eifrig et al. 2003). Antibiotic prophylaxis preferences before PPC IOL implantation varied widely among the surgeons, with 43% of surgeons using no antibiotic drugs preoperatively (Allan et al. 2009) like our case. Although the cause of the infection in our case remains uncertain, postoperative outbreaks have been described in association with contaminated intraocular irrigation solutions (Eifrig et al. 2003), and the exchange of PPC IOL may increase the risk of endophthalmitis. Therefore, the risk of infectious endophthalmitis after PPC IOL implantation should be always considered especially when the reoperation is required. In addition, it emphasizes the need for a careful preoperative examination, for a proper surgical technique, for a strict postoperative surveillance and for an informed consent about the potential for sight-threatening complications.