1. Dealing with the scariest complication in cataract surgery Dealing with the scariest complication in cataract surgery Ian Francis

2. Surfing :

3. Leonardo era un pittore straordinario pittore straordinario

4. First : the most important word in the English language : Ontological : do you believe what you just saw ??

5. ONTOLOGICAL : “ The way things really are …” FOR EXAMPLE : FOR EXAMPLE : 1. Life 1. Life 2. Your spouse 2. Your spouse 3. Your children 3. Your children 4. God 4. God 5. Surfing 5. Surfing 6. Medicine 6. Medicine 7. Optometry 7. Optometry 8. Ophthalmology 8. Ophthalmology 9. Refractive surgery 9. Refractive surgery 10. Neuro-ophthalmology ………… 10. Neuro-ophthalmology …………

6. It’s ontological : All Ophthalmology and Optometry is Neuro-ophthalmology

7. All Ophthalmology and Optometry is Neuro-ophthalmology Why ?? …. because much as anyone may or may not like it : may or may not like it : The eye bone is connected to 1. the brain bone 1. the brain bone 2. the body bone 2. the body bone

8. Dealing with the scariest complication in cataract surgery

9. Endophthalmitis : E : E

10. E : Only happens because someone has been operated !!

11. Anthony Pane : Neuro- ophthalmologist extraordinaire Everyone in Medicine should read this….

12. Med J Aust October 2008 “ Misdiagnosis of acute eye diseases by “ Misdiagnosis of acute eye diseases by primary health care providers: incidence and implications “ …. primary health care providers: incidence and implications “ …. 1. Michael O. Statham : RMO : MB BS(Hons), BAppSci(Optom)(Hons) 2. Anamika Sharma : Registrar : BmK BS(Hons), BMedSci(Hons) 2. Anamika Sharma : Registrar : BmK BS(Hons), BMedSci(Hons) 3. Anthony R. Pane : VMO : MB BS(Hons), MMedSc, FRANZCO 3. Anthony R. Pane : VMO : MB BS(Hons), MMedSc, FRANZCO

14. For E : It is of supreme importance not to 1. underdiagnose E 2. misdiagnose E 3. treat E as of little consequence

15. E 1. Is either local or metastatic 2. May requires lots of medical work to confirm 3. May be life-threatening….

16. E : metastatic … patient referred urgently from the EH

17. Sinus venosus

18. Diagnosing E : YOU MAY BE IN THE BOX SEAT

19. E : 1. Vast majority have had cataract surgery 2. Within a few days of the operation, things head south, often rapidly often rapidly 3. Day 1: vision 6/4 or 6/12 vision 4. Vision on day 4 : HM or worse 5. Pain 6. Loss of the red reflex 7. Hypopyon

20. …examination requires finesse …

21. E : Is getting the instructions for the postoperative drops correct really important ?……

23. The story of a patient of mine with E with E

24. E story Don : DOB 280726 Don : DOB 280726 280704: R phaco Wednesday : uneventful 290704 : Thursday : Day 1 pop : VAR : 6/4 020804 : Monday 7.40pm : Day 5 pop : VAR : PL VAR : PL All stops pulled out by the VR team ……..

25. E : VA last week was npl

26. E : the other eye : 6/4

27. Endophthalmitis following cataract surgery : the sucking corneal wound Athena Roufas MBBS (Hons), MM (Ophthal Sci) Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci) Edwin C. Figueira MBBS, MSc, MS (Ophthal) Shahriar Amjadi B Sc (Hons), MBBS Gaurav Bhardwaj BMed Josh Baker Katherine Masselos MPH, MB, BS (Hons) Fiona Stapleton PhD Sarosh Batliwalla BEc, MEc, MIntS, FIAA Katherine E. Francis BE (Hons) Rahul Dubey MBBS (Hons) Jeanie Chui B Med Sci (Hons) MBBS PhD Ian. C. Francis FASOPRS, PhD

28. The sucking chest wound !!

33. Is E important ?  What is the world “accepted” rate of E  It is said to be 0.1% : 1/1000

34. Is E important in Oz? NSW has a rate (1998-2004) of 0.823%: >8/1000 Is this really true ??

35. Risk factors for acute endophthalmitis after cataract surgery: a population- based study. Risk factors for acute endophthalmitis after cataract surgery: a population- based study. Hatch WV et al Ophthalmology. March 2009 116:425-30.

37. April 2009 April 2009

39. April 2009  Nick Mamalis  Editor JCRS  Professor of Ophthalmology  Nick.Mamalis@hsc.utah.edu  Nick.Mamalis@hsc.utah.edu Nick.Mamalis@hsc.utah.edu  (John A.) Moran Eye Center : 0011 1 801 581 2352 0011 1 801 581 2121 (Emergency Switch : the best number; they will contact his home) Office : 801 581 6586 Pager : 801 339 0763

40. 1 st May 2009 Emanuel Rosen FRCSE Editor JCRS Manchester, England