Aims To estimate the incidence of acuteonset presumed infectious endophthalmitis (PIE) following cataract surgery in the UK and provide epidemiological data on the presentation, management, microbiology, and outcome of cases of endophthalmitis. Methods Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period October 1999 to September 2000 inclusive. Questionnaire data were obtained from ophthalmologists throughout the UK at baseline and 6 months after diagnosis. Under-reporting was estimated by independently contacting units with infection databases. Results Data were available on 213 patients at baseline and 201 patients at follow-up. The minimum estimated incidence of PIE was 0.086 per 100 cataract extractions and the corrected incidence was 0.14 per 100 cataract extractions. For the management of PIE, 96% of patients received intravitreal, 30% subconjunctival, 65% oral, and 17% intravenous antibiotics. In all, 17% of patients received intravitreal steroid. From the intraocular samples taken for microbiological analysis, 56% were culture positive. At followup, 48% of patients achieved visual acuity of 6/ 12 or better and 66% achieved better than 6/60. 13% of patients were unable to perceive light or had evisceration of the globe. Conclusions The incidence of PIE after cataract surgery in the UK is comparable to that of other studies. Approximately 50% of patients achieved a visual acuity close to the driving standard.

This study suggests that MMC is more effective than 5-FU for needle revision of failed trabeculectomy blebs.

Candida endophthalmitis is associated with a high rate of visual loss, particularly in patients with poor presenting visual acuity or centrally located lesions. Early vitrectomy reduces the risk of retinal detachment.

-Metastatic or endogenous endophthalmitis (EE) is a serious consequence of systemic sepsis. It is defined as intraocular infection resulting from haematogenous spread of organisms in which the initial focus of infection is at a site distal to the eye. A red/sore eye in a patient with a known septic focus needs urgent attention as EE can be a major cause of visual loss. Early diagnosis and treatment are associated with better visual outcome. This article focuses on the two main causes of EE, namely bacterial and fungal infections, and also briefly mentions dissemination of cytomegalovirus to the eye in immunocompromised patients. Although conscious patients may notice an ocular problem, unconscious or very sick patients may not; vigilance by medical staff in looking for early signs of this is extremely important.KEY WORDS: candida, ciprofloxacin, cytomegalovirus (CMV), endophthalmitis, floaters, hypopyon, red eye, retinal infiltrates, retinitis, septicaemia Endogenous fungal endophthalmitisFungal sepsis is identified most frequently in hospitalised patients who are seriously ill. Endogenous fungal endophthalmitis (EFE) occurs in 28-45% of patients with candidaemia 1,2,3 and is the most common form of endogenous endophthalmitis (EE) 4 . Patients usually present with floaters and decreased vision, unilateral or bilateral. Onset is often insidious; in its early stages EFE can be asymptomatic 2 , but if left untreated can have devastating consequences for visual function. Therefore, regular screening of high risk cases is undertaken in many centres 5,6 . High risk characteristics include those listed in Table 1. CandidiasisCandida albicans is the most common pathogen causing EFE and in some series is the causative agent in 85-99% of all cases 6,9 . Non-albicans candida spp are important as aetiological agents 10 because fungaemia with these species is associated with a higher incidence of endophthalmitis than with C. albicans 11 . Other causes of EFE in descending order of importance are Aspergillus fumigatus, cocciodioides, cryptococcus, fusarium, histoplasmosis and paecilomyces 4 .Diagnosis of ocular candidiasis. The clinical diagnosis of ocular candidiasis is largely made on the ocular appearance 8 . The organism typically causes inflammation in the choroid and retina, with subsequent spread into the vitreous cavity 8 . The ophthalmoscopic appearance is of one or more creamy-white, usually round and sometimes elevated retinal lesions, often sited in the posterior pole of the eye (Fig 1). They may vary in size from small pinpoint lesions to two-disc diameter in width 8 . If the vitreous is involved, multiple clumps may form ('puff balls') (Fig 2). Thread-like strands may connect these, producing a so-called 'string of pearls' appearance. Ocular lesions can indicate otherwise occult deep tissue fungal infection and are useful indicators of systemic candidiasis 12,13 . Although autopsy studies have demonstrated a high incidence (78%) of ocular involvement in patients with candidaemia 12 , the eye can be the ...