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AIM: Endophthalmitis remains one of the most dreaded complications of modern cataract surgery. Its incidence in the UK has been estimated but accurate published data on the incidence at a regional level are scarce. This audit examines the incidence and visual outcome of endophthalmitis from a single eye department in Scotland (UK) over a 7-year period. Findings are compared with those from other series. METHODS: A retrospective consecutive audit of all cases of acute endophthalmitis treated between 1 January 2000 and 31 December 2006 at the Southern General Hospital in Glasgow (Scotland, UK) was undertaken. Details of each case (presentation, treatment and outcome of endophthalmitis) were recorded. Cross-tabulations were performed to identify prognostic factors of visual outcome. RESULTS: Twenty-five patients were treated for endophthalmitis over the audit period. The incidence of endophthalmitis was 0.20% (95% CI 0.10 to 0.30%). There were 12 (48%) culture-positive cases with coagulase-negative staphylococcus accounting for 58%. After treatment, 16 patients (64%) achieved driving-standard vision or better. Poor vision at presentation and streptococcal endophthalmitis were associated with poor visual outcome. CONCLUSION: The incidence of endophthalmitis in this series is comparable to larger studies, suggesting that accepted benchmarks, despite being estimates, reflect UK practice. Visual outcome, with treatment, can be favourable in a significant proportion of patients.

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PURPOSE: To determine whether systemic diclofenac sodium affects the maintenance of mydriasis during phacoemulsification and to compare pupil diameter regression rates with those in a control group. SETTING: An ophthalmic unit of a National Health Service Trust Hospital in the United Kingdom. METHOD: A prospective, randomized control study of 100 patients presenting for cataract surgery was undertaken. Both groups were administered an identical mydriatic regime commencing 1 hour before surgery. In addition, the diclofenac group (n = 48) received 50 mg of oral diclofenac sodium 1 hour before surgery. Both the control (n = 52) and diclofenac groups had phacoemulsification by one experienced surgeon using a standard technique. The surgeon was masked as to which group the patient belonged. The irrigating fluid in all cases contained adrenaline. Pupil diameter was measured at five stages during surgery and recorded along with the times relative to the start of the procedure. RESULTS: Mean pupil diameter in the diclofenac group was slightly larger than in the control group, but the difference was not significant. Although mean pupil diameter at the start of surgery was 0.4 mm greater in the diclofenac group, the slopes of regression in pupil diameters were virtually identical between the first three stages of surgery, after which a slight reversal occurred in both groups. The slope of regression of mydriasis was small in both groups. CONCLUSION: Systemic diclofenac sodium 50 mg given orally 1 hour before surgery did not significantly inhibit miosis when compared with a control group. Regression rates of pupil mydriasis were small in both groups.

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A scanning laser ophthalmoscope (SLO) was used to examine the fundi of 54 diabetic patients through undilated pupils and the results compared by an experienced ophthalmologist with clinical examination through dilated pupils to assess the effectiveness of the SLO in detecting diabetic retinopathy. Whilst the SLO was not as good at detecting cotton wool spots and subtle intraretinal microvascular abnormalities, it did not miss any active new vessel formation and all eyes needing treatment would have been referred.

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Focal retinal pathology and dysfunction as a sequel to manifest damage due to operating microscope illumination is well recognised. We wished to determine whether retinal dysfunction could be identified in the absence of clinically visible lesions. We therefore have conducted a prospective controlled study on 36 patients undergoing cataract surgery and 27 control subjects. A Wild M690 zoom operating microscope was used for each procedure. No filters were used. The Humphrey visual field equipment was employed to determine threshold retinal sensitivity at predetermined loci above and below fixation in both groups. No clinically visible retinal lesions were seen in any patient. However, post-operative investigation revealed a statistically significant depression in retinal sensitivity at points most exposed to operating microscope illumination (p < 0.05). This was most noticeable following longer total operating times and in patients with the longest time intervals between lens extraction and completion of the procedure. It is concluded that operating microscope position and centration, and the position of the eye, should be adjusted to place the image of the illuminating element away from the foveola. Also retinal illumination should be kept to a minimum, particularly after an intraocular lens has been implanted.

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In this study 374 consecutive fundus fluorescein angiograms (FFAs) were performed on 330 patients. Of these, 165 (50%) were investigated for age related maculopathy. In only 12% did this investigation lead to an alteration in treatment. The remaining 50% of angiograms were requested for diabetic patients (15%), retinal vein occlusion (5%), tumours (6%), and various other disorders. In the diabetic patients treatment could have proceeded without FFA in 24% of patients who underwent it. Missed diagnoses corrected by angiography and areas where unnecessary angiograms were performed were identified. One interesting subgroup of eight patients with unexplained loss of central vision was identified. Careful clinical examination had failed to reveal any abnormality. FFAs were of no diagnostic value in these patients.

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A 3-month-old child received severe rat bit injuries to the face, including subtotal loss of upper and lower lids of one eye. The presentation and management are discussed.

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A retrospective survey was performed of all penetrating eye injuries in Gwent from 1976 to 1985. It included 171 eyes. The results showed a gradual decline in all penetrating injuries and not just those due to road traffic accidents. An analysis of the cause and prognosis is given.

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A patient presented with a painful third nerve palsy. This resolved spontaneously, but recurred several months later. At his second presentation carotid angiography gave normal results, but a high resolution CT scan showed a tumour in the right parasellar region. The serum prolactin was raised at over 22,000 millimicrons/, showing this to be a prolactinoma.

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A patient presented with headache, soreness over her scalp and general malaise. She was treated for hypertension, but later went blind in one eye. Following referral to the Eye Department, she was treated successfully for six episodes of blindness in her second eye. The case highlights the ways in which temporal arteritis may present. Prompt treatment will save vision, but a missed diagnosis may result in blindness.

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