Introduction. Abiotrophia defectiva is a fastidious organism that has been implicated in severe infections such as endocarditis in immunocompetent patients. Modern tools are available to aid identification, but the main challenge remains clinical suspicion of A. defectiva . Case presentation. An otherwise fit and well 65-year-old female presented with reduced vision, red eye and discomfort 2 days following routine left cataract surgery. She had visual acuity of light perception only, significant anterior chamber inflammation (including hypopyon) and limited fundal view. She was diagnosed with post-operative endophthalmitis and 0.1 ml of ceftazidime (2 mg/0.1 ml) and 0.1 ml vancomycin (2 mg/0.1 ml) were injected intravitreally after vitreous aspiration. Subconjunctival cefuroxime was also injected. A repeat injection was performed on day three of admission. Gram staining revealed Gram-positive long-chain cocci, which were identified as A. defectiva . The patient was discharged on oral ciprofloxacin 500 mg twice a day with oral prednisolone 60 mg once a day; this was tapered and stopped at 8 weeks post-discharge. The left eye received dexamethasone 0.1 % 6 times a day (again, tapered over 8 weeks), moxifloxacin 5 % 6 times a day and atropine 1 % twice a day. Vision improved to 6/12 unaided (6/9.5 with pinhole) at 9 weeks post-operatively, with a clear fundal view. Conclusion. We present a case of A. defectiva endophthalmitis following routine cataract surgery. To our knowledge, this is the first reported case in the UK and the fourth globally, which with prompt treatment ended with a good visual outcome.

Methylene blue (MB) has many uses in medicine, being applied as a treatment for infections, malaria, methemoglobinemia, as a dye for diagnosis and for staining of cells, tissues and bacteria. In elderly patients with associated high anaesthetic risk, dacryocystectomy is an alternative to dacryocystorhinostomy. This is an observational clinical study for two cases of chronic dacryocystitis where dacryocystectomy combined with MB (1%) staining of lacrimal sac was performed. Case no.1 - an 81-year old female patient with arterial hypertension, atherosclerosis, pulmonary fibrosis, and lower limb varices complainted of recurrent epiphora, muco-purulent secretions in both eyes, inflammatory oedema of the left perisacular region for the past 6 months. Case no. 2 - a 74-year old female patient with hypothyroidism suffered from chronic epiphora in the left eye with a purple-red oedema of the inferior eyelid and perisacular region. Symptoms reoccurred in the last 10 months despite topical and systemic therapy with antibiotics and anti-inflamatory drugs. Dacryocystectomy was performed under local anaesthesia in both patients. MB (1%) was used to irrigate the lacrimal sac in order to facilitate its localisation, dissection and excision. Results: Case no.1. Ectopic lacrimal sac. Case no.2. Enlarged lacrimal sac (7.5/14 mm). The histopathological examination revealed a trachomatous dacryocystitis, respectively a chronic non-suppurative non-granulomatous dacryocystitis. Their postoperative evolution was without complications, except for a mild epiphora. In conclusion, dacryocystectomy appears to be a less traumatising alternative to dacryocystorhinostomy. The staining of the lacrimal sac with MB (1%) in dacryocystectomy facilitates its identification and dissection, especially when it is ectopic.

BackgroundNeodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy is a common treatment for posterior capsular opacification. Practice varies regarding routine follow-up. In this study, we reviewed follow-up rates and treatment-related complications from a district general hospital's ophthalmology unit to assess areas for improvement and cost-effectiveness. MethodologyWe conducted a retrospective review of electronic patient records for all patients treated with Nd:YAG capsulotomy in 2019 at our hospital. Primary outcomes included visual acuity, complications, and follow-up data. Secondary outcomes included medication prescribing and the grade of surgeon. ResultsIn total, 912 eyes of 744 patients were included. Overall, 536 (58.8%) eyes were discharged immediately following their laser. Complication rate was 4.3% (39 eyes). Junior training grades had a higher rate of medication prescribing (40/46 eyes; 87.0%) and follow-up (36/40 eyes; 78.3%). ConclusionsCertain selected patients may be safely discharged following capsulotomy with safety-netting advice. This strategy increases the capacity to follow-up patients at higher risk of complications. Higher rates of followup among junior ophthalmologists offers potential for training.

Necrotising scleritis is a rare, inflammatory condition with potentially devastating visual consequences. It can be associated with inflammatory and infectious causes, and has been linked to several different ocular procedures. We present a difficult case of a patient with surgically-induced necrotising scleritis following routine phacoemulsification cataract surgery, who developed a secondary Nocardia bacterial infection. He required a number of surgical interventions and prolonged antibiotic therapy, suffering recurrent scleral abscesses. A literature review accompanies our case report. Prompt recognition and adequate investigation for underlying inflammatory and infective causes are vital to maintain integrity of the globe and ensure suitable treatment of this challenging condition.

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