Roibeard O’hEineachain in London INSPIRED by the findings of the ESCRS endophthalmitis study, a symposium at the XXIV Congress of the ESCRS in London addressed the topic of endophthalmitis

INSPIRED by the findings of the ESCRS endophthalmitis study, a symposium at the XXIV Congress of the ESCRS in London addressed the topic of endophthalmitis following cataract surgery.The Symposium was chaired by Ulf Stenevi and Jose Güell. Presenters provided updates on the current knowledge in the aetiology, diagnosis and treatment of endophthalmitis, and also provided suggestions on how the complication might be avoided.The session concluded with the Ridley Medal Lecture, delivered by Peter Barry FRCS, who provided an analysis of the ESCRS endophthalmitis study results. The coordinator of the ESCRS endophthalmitis study, David Seal MD, Applied Vision Research Centre, City University, London UK, commenced the symposium with an overview of the sources and types of bacteria and fungi that are known to cause endophthalmitis following cataract surgery. Dr Seal noted that the greatest source of bacterial contamination leading to endophthalmitis is the patient’s own microbial flora. He pointed out that 85-90 per cent of patients’ lids and conjunctiva are colonised with staphylococci.Around 10 per cent of patients’ lids are colonised with S aureus; however, in patients with asthma or atopy the rate of colonisation with the pathogen in eyelids and noses is up to 70 per cent. Methicillin-resistant S aureus (MRSA) is a less common cause of endophthalmitis following cataract surgery in Europe than in the US, he noted.The reasons for this are unclear, although it may be due to a selection bias at the tertiary referral centres in the US where the reports have come from. “In our experience in Europe and Scandinavia, MRSA is present in the hospitals but not in the community to a sufficient degree that patients coming from the community for day case surgery are colonised with MRSA and infection would occur.At the moment it is a very rare organism to cause postoperative endophthalmitis in Europe.” Streptococci appear to be making resurgence as a cause for endophthalmitis. In the UK this is especially true of the alpha-haemolytic streptococci, which may reflect the prevalence there of chronic bronchitis with streptococcal colonisation, Dr Seal suggested. Surgical theatre hygiene important