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Purpose: To assess the quality of processed ophthalmic instruments and look for the presence of foreign material on the surface of these instruments., Methods: Data were prospectively collected on the presence of debris on processed instruments in the trays used for phacoemulsification surgery. All instruments were examined under an operating microscope before use and details of the types of debris on the various instruments were noted. If debris was found, a new tray was opened to obtain a clean instrument., Results: Forty-seven trays were opened for use during the study period. Deposits on instruments were found in 29 (62%) trays. These were mainly present on the intraocular lens introducers. Loose fibres were found on instruments from eight (17%) trays. Debris was found in the aspiration channels of three (6%) hand pieces., Conclusions: A significant number of processed ophthalmic instruments had debris on their surfaces. To reduce the risk of intraocular inflammation and of transmission of prion diseases the instruments should go through a thorough decontamination process before sterilization. Routine mechanical cleaning at the end of surgery and ultrasonic cleaning before sterilization should reduce the occurrence of debris on the instruments. Instruments should also be inspected under the operating microscope before use.

Endophthalmitis is a serious postoperative complication of phacoemulsification surgery. Administration of a subconjunctival antibiotic is a common method of prophylaxis in the United Kingdom and other countries. Injection of subconjunctival cefuroxime can be very painful, especially after phacoemulsification under topical anesthesia. Our experience is that this could be the only painful step in the entire operation. We evaluated a technique in which buffered lignocaine is injected into the subconjunctival space before the antibiotic injection. The technique was used in 46 eyes (46 patients) that had phacoemulsification under topical anesthesia. Eighty-seven percent of patients found the injection painless, 6.5% reported that the pain was very negligible, and 6.5% reported a moderate degree of pain.

Purpose: To report a case of Mycobacterium avium-intracellulare (MAI) keratitis successfully treated with topical clarithromycin. An unreported side effect of the topical medication is described., Methods: A regular follow-up in the corneal clinic was arranged, and a pertinent literature search performed., Results: The use of topical clarithromycin was successful in treating the keratitis. The patient did not complain of any ocular discomfort. Corneal subepithelial deposits that appeared during treatment with clarithromycin resolved shortly after the therapy was discontinued., Conclusion: This case report demonstrates that a rare infection like MAI keratitis can be successfully treated with topical clarithromycin. It also highlights the possible corneal deposition of this drug, which resolved after cessation of therapy.

We report a case in which posterior capsule rupture, vitreous loss, and vitreous hemorrhage were caused by a dislodged, flying cannula during phacoemulsification. We modified our surgical practice since the occurrence of this unusual complication and use Luer-lock syringes during surgery. This measure should prevent the recurrence of this complication.