The microbiology of endophthalmitis: global trends and a local perspective.

Endophthalmitis is a rare but frequently devastating infection, caused by diverse organisms, including bacteria, viruses, fungi, and parasites. The causative agents of endophthalmitis vary according to the mechanism. The involvement of intraocular structures can result from exogenous spread from ocular trauma, infection of adjacent structures, or as a complication of intraocular surgery. Of the causes of exogenous endophthalmitis, post-operative endophthalmitis is the most frequently encountered; specifically, cataract surgery is the most frequent eye surgery and, thus, leads the list of surgery-associated endophthalmitis. Exogenous source is far more common than endogenous endophthalmitis, a disease that is caused by the hematogenous spread of organisms from a remote infectious site to the eye, leading to severe visual loss. Several large series estimate that endogenous endophthalmitis accounts for 2-15 % of all cases of endophthalmitis. Progressive vitritis is a hallmark for all forms of endophthalmitis, accompanied by intraocular inflammation, loss of vision, pain, and hypopyon. The common presentation consists of reduced vision, conjunctival injection, pain, and eyelid swelling. We reviewed the microbiology of endophthalmitis during a 9-year period in Winnipeg, Canada. Gram-positive bacteria with coagulase-negative staphylococci are the most common causative organisms, reflecting the association with surgical procedures.

Large soft contact lenses in the management of leaking blebs.

PURPOSE: To investigate the efficacy of a new large permanent wear soft contact lens in the management of leaking blebs following trabeculectomy. METHODS: Twenty-four patients with leakage from a trabeculectomy bleb, both fornix based and limbal based, with and without mitomycin adjuvant, were treated with a 78% water content soft contact lens of 17.5 mm diameter, fit according to each patient's keratometry readings. RESULTS: The leakage from a conjunctival trabeculectomy bleb was successfully treated in 22 out of 24 patients. CONCLUSIONS: The 17.5 mm 78% water content permanent wear soft contact lens is a preferred method of management of leaking blebs when specifically tailored to the patient's corneal curvature.

Epidemiology of Shigella infections in two ethnic groups in a geographic region in southern Israel.

The epidemiology of shigellosis in the Jewish and Bedouin populations that coexist in the same geographic region in southern Israel and share the same medical facilities but live separately under different socioeconomic conditions was examined in a retrospective, culture-based study. The average annual attack rate for the four-year period 1989-1992 was 368/100,000 inhabitants. The average annual attack rate among the Jews, who enjoy Western socioeconomic conditions, was 413/100,000 and the disease showed summer and winter peaks. Shigella sonnei caused 3,336 of 4,560 (73.2%) attacks in this group, and the attack rate of Shigella flexneri decreased during the study period. Among the Bedouins, many of whom live in poverty and overcrowding, a single annual summer peak was observed, the average annual attack rate being 197/100,000 and Shigella flexneri caused 389 of 583 episodes (66.7%). Resistance to ampicillin or tetracycline was noted in 57% of all Shigella isolates, and 82% were resistant to cotrimoxazole. It is concluded that shigellosis is highly endemic in southern Israel, resistance to antimicrobial drugs is common and living conditions of the population influence the seasonal occurrence of the disease and select for morbidity with specific organisms.