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.

Aims To study risk factors for presumed infectious endophthalmitis complicating cataract surgery in the United Kingdom. Methods Two hundred and fourteen clinically diagnosed patients with presumed infectious endophthalmitis were compared with 445 control patients throughout the United Kingdom in a prospective case-control study. The cases were identified through the British Ophthalmological Surveillance Unit reporting card system. Control patients undergoing cataract surgery from 13 'control centres' throughout the United Kingdom were selected randomly. Risk factors were identified by univariate and multivariate logistic regression analyses. Pertinent variables relating to the cataract extraction procedure, antimicrobial prophylaxis, ophthalmic and medical history were analysed with regard to postoperative infection. Results Statistically significant risk factors in the multivariate model included inpatient cataract surgery (P ¼ 0.001), surgery in dedicated eye theatres (Po0.001), consultant grade surgeon (compared to registrar) (P ¼ 0.001), posterior capsule tear during cataract surgery (P ¼ 0.001). The use of face masks by the scrub nurse and surgeon during cataract surgery (Po0.001) and the administration of subconjunctival antibiotics at the end of surgery (Po0.001) were protective against postoperative infection. Conclusions In order to minimise the risk of postoperative endophthalmitis we would recommend the wearing of face masks by the surgeon and scrub nurse during cataract surgery and subconjunctival antibiotics at the end of surgery.

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A dense infiltrate of medium-sized cells can be observed beneath a multilayered epithelium. Round nuclei and relatively scanty cytoplasm are evident. XI0 (b) At higher magnification the nuclei appear cleaved and elongated and epithelial clumps are sometimes surrounded by the abnormal lymphocyte proliferation. x2S. immunophenotypic profile (Fig. 2). The picture was consistent with a conjunctival localisation of the lymphoid tumour. Radiation therapy was carried out for over 3 weeks at a dose of 30 Gy, achieving complete regression without any serious side effects. Systemic and ocular follow-ups were carried out on a monthly basis to detect any further progression of the disease. After an interval of 10 months the patient presented a relapse of the tumour in his left orbit, with proptosis, ptosis and diplopia. Two large palpable nodular masses were also detectable over the left globe. The patient underwent a new cycle of radiation therapy, with complete resolution of the clinical picture.Further follow-up lasted 18 months without any relapses. Unfortunately, the patient died from a heart attack 2 months after his last ophthalmic visit. DiscussionAs mentioned above, the frequency of conjunctival involvement in non-Hodgkin lymphoma is rather low, and is even rarer bilaterally. Recurrence of the tumour in the orbit is also unusual.The choice of treament we adopted followed the criteria suggested by Reddy et al.l Biopsy, when feasible, should always be obtained to determine the histological features and immunophenotypic analysis. On the basis of the staging of the disease, provided by a radiotherapy specialist, radiotherapy treatment is generally recommended.Bilateral anterior uveitis associated with 0.3% Minims metipranolol Metipranolol is a topical beta-blocker, which was introduced to the United Kingdom for the treatment of glaucoma in 1986. Adverse drug reactions to metipranolol were reported by Akingbehin and Villada, l who described granulomatous anterior uveitis, blepharoconjunctivitis and periorbital dermatitis. In 1991 multidose preparations of metipranolol and the single dose Minims preparation of metripranolol 0.6% were withdrawn from the United kingdom market. Case reportWe report a patient with bilateral granulomatous anterior uveitis which was associated with single-dose metipranolol 0.3% therapy. A 61-year-old man was diagnosed with open angle glaucoma in June 1992. His corrected acuity was 6/6 in both eyes wearing -5.25 DS right eye and -5.00 DS left eye. The ocular pressures were 24 mmHg right eye and 22 mmHg left eye; the angles were wide open with heavy pigmentation. The glaucoma was controlled with timolol 0.5% until September 1995, when he developed irritation of both eyes and the medication was changed to preservative-free Minims metipranolol 0.3%. The ocular pressures were 28 mmHg right eye and 16 mmHg left eye. Dorzolamide 2% drops were then added twice a day in both eyes.