The aim of glaucoma surgery is to lower the intraocular pressure in order to reduce the risk of further glaucomatous progression, particularly in cases refractory to topical therapy. Although effective in reducing intraocular pressure, these procedures are not without complications, with endophthalmitis being one of the most serious. A PubMed review of the literature was performed for trabeculectomy, glaucoma drainage device procedures (Ahmed, Baerveldt and Molteno implants) and non-penetrating glaucoma surgery (deep sclerectomy and viscocanalostomy) for reports of postoperative infection, including blebitis and endophthalmitis. The literature on infections relating to non-penetrating glaucoma surgery is sparse compared with penetrating surgery, but this may be a reflection of the relatively shorter follow-up duration and comparatively smaller body of data available on non-penetrating procedures. Overall, there is not enough evidence, in terms of well-constructed randomised clinical trials with sufficiently large sample sizes and long follow-up durations, to be able to make informed comparisons of the risk of postoperative endophthalmitis and infection between the various glaucoma operations. This review article summarises the incidences of endophthalmitis from the literature and discusses the major risk factors for postoperative infection.

Deep Sclerectomy is a non penetrating surgical procedure for the treatment of open angle glaucoma. In this article we will describe the surgical technique, the indications for surgery and will review the scientific literature on surgical outcome following this procedure. We will also discuss the important role played by antimetabolites, implants and the use of gonipuncture to achieve the desired IOP reduction.

Aims The purpose of this randomized clinical trial was to compare the effectiveness and safety of viscocanalostomy (visco) with trabeculectomy (trab) in the management of primary open angle glaucoma (POAG). Methods Patients were randomized to have a viscocanalostomy (25 eyes) or a trabeculectomy (25 eyes) performed by one surgeon (TDM) and followed up prospectively. Patients were examined preoperatively, at day 1, day 3 if required, day 6, week 2 and thereafter as near as possible to 1,3,6,12, 18, 24, 30, 36, 48, 54, and 60 months. We recorded intraocular pressure (IOP), presence or absence of any complications, presence and description of any bleb, visual acuity with glasses, and full examinations as routine to monitor any progression of the glaucoma. Bleb interventions including needling and antimetabolites were allowed and recorded in both groups. YAG laser goniopuncture was allowed in the viscocanalostomy group. Results Mean follow-up was 40 months (SD 15), with a range from 6 to 60 months. Forty-two percent (n ¼ 10) of the patients in the trabeculectomy group had a successful outcome (IOPo18 mm Hg with no treatment) at last follow-up visit, compared to 21% (n ¼ 5) in the viscocanalostomy group. IOP was lower in the trab group with differences in IOP being statistically significant at month 12 (P ¼ o0.001), 24 (P ¼ o0.001), 30 (P ¼ 0.030), 36 (P ¼ o0.001), and 48 (P ¼ 0.018). The trabeculectomy group required less postoperative topical IOP-lowering medication (P ¼ 0.011). ConclusionIn this study, we found trabeculectomy to be more effective at lowering IOP than viscocanalostomy in POAG patients.

bThere is growing evidence for the role of rubella virus in Fuchs' uveitis syndrome (FUS). This report is the first to show persistent intraocular rubella virus in a 28-year-old man with congenital rubella syndrome (CRS), who presented with blurred vision and was diagnosed with FUS. CASE REPORTA 28-year-old man of Afro-Caribbean descent was referred to a tertiary hospital in 2006 with progressively worsening vision in both eyes. There was no history of pain, conjunctival injection discharge, photophobia, photopsia, or floaters. He had been diagnosed at birth with congenital rubella syndrome (CRS), following a clinical diagnosis of maternal rubella in pregnancy and presentation with profound deafness and cataracts. He did not have any cardiac defects. His visual acuities on presentation in 2006 were 6/36 and 6/12 in the right and left eye, respectively. Examination revealed bilateral anterior uveitis with stellate keratic precipitates as well as bilateral posterior subcapsular lens opacities. Intraocular pressures were within normal limits in both eyes. Dilated fundus examination was normal.The clinical diagnosis of Fuchs' uveitis syndrome (FUS) was made based on the presence of a bilateral low-grade anterior uveitis with typical keratic precipitates and the absence of posterior synechiae or acute symptoms of pain, redness, and photophobia. Investigations for other causes of uveitis were carried out, including serum angiotensinogen-converting enzyme, syphilis serology, and antinuclear antibody titers, which were all negative. The full blood count, renal and liver function tests, and erythrocyte sedimentation rate (ESR) were normal, and the sickle cell screen was negative. The serum rubella IgM was negative, and the rubella IgG was positive.His reduced visual acuity was attributed to his bilateral lens opacities, which is a common feature of FUS. Right followed by left eye phacoemulsification cataract extraction and intraocular lens implantation were performed under general anesthesia to improve vision. One-hundred-microliter samples of aqueous humor (AH) were aspirated through a paracentesis prior to both cataract surgeries. The rest of the operations were performed in a standard manner and without complications. The postoperative treatment regimen consisted of hourly dexamethasone as 0.1% drops that were tapered over 6 weeks and with chloramphenicol as 0.5% drops 4 times a day (q.d.s.) for 1 week.A venous blood sample, urine sample, and throat swabs were collected for serological and microbiological investigations. The serum sample confirmed serological evidence of past rubella infection with an unusually high titer (Table 1). Samples of aqueous fluid were sent to the national rubella reference laboratory at Colindale, United Kingdom, for detection of rubella RNA and intraocular antibody production, by calculating the rubella-specific antibody index (AI Rub ) based upon the Goldmann-Witmer index (GW-I) (1). This compares the relative levels of specific antibody in aqueous and serum samples and compares them with...

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