Postoperative endophthalmitis is the most dreaded complication of any intraocular surgery with the reported incidence of 0.04%--0.4% . POE should be suspected in any patient with inflammation more than expected from the surgically induced trauma. Management includes intravitreal administration of injection vancomycin and ceftazidime if initial vision is HM or better. Pars plana vitrectomy is done if there is no response or worsening within 48 hrs of intravitreal injection. Retrospective study was performed in 96 patients of early POE between 1996 to 1999. All eyes received intravitreal injection of vancomycin 1 mg+ceftazidime 2.25 mg with or without PPV. Successful anatomical outcome was seen in 69 eyes(72.9%) and successful functional outcome in 39 eyes (39.58%).

The Presentation deals with the predisposing causes of globe perforation during local anaesthesia, the management of acute globe perforation as well as sequelae of same brief observations as how to avoid globe perforation will also be made. Significant among the developments that involve the avoidance of globe perforation are use of peri,para bulbar and topical anaesthesia in preference to retrobulbar anaesthesia, use of relatively blunt needles in preference to disposable needles. Significant developments in the management of perforation and its sequelae are the advent of vitreoretinal techniques including use of relaxing retinotomies, gas and silicone oil tamponade etc.

It is well established that CRVO is of two types- non-ischemic and ischemic.

The subspeciality of vitreous and retina in ophthalmology is unique. It requires more training,more time more instrumentation and is less rewarding in its outcome and statistical results. It is the challenging and enterprising aspect of it which attracts. It gives a lot of excitement to deal with difficult situation. One must go with these expectation in to this branch and should be prepared to meet the failures. Our personal experience in meeting these situation will be presented.

Increasing incidence of diabeties mellitus poses a major health problem in India. The WHO has projected that there will be 57 million diabetic patients in India by the year 2025. Our own estimate suggests that 4 to 5% of our population ,above the age of 40 years,will have diabetes. Irrespective of duration of diabetes,30% of diabetics will develop diabetic retinopathy. According to WHO,after 15 years of diabetes 2% become blind and 10% become severe visually disabled. Unless they are subjected to periodic eye examination and screening it is difficult to detect early stages of diabetic retinopathy. It is high time that India needs a project considering creating awareness,training of man power,health education, diabetic retinopathy screening and provide tertiary care.

Extreme trauma cases with extensive damage to ocular tissues are difficult situation to manage. This group comprises of either no perception of light eyes or traumatised eyes in which identification of tissue planes were difficult. Some authors advice to enucleate the eyes with the purpose of avoiding sympathetic ophthalmia in the other eye. We advocate primary repair of even these badly damaged eyes followed by vitreo retinal surgery three weeks later. This gives a chance of visual recovery,if any,and saving the patients from the psychological trauma of removal of eye.

The timing of vitreous surgery intervention could be crucial in the management of open globe trauma involving the posterior segment. A primary surgical wound closure must be carried out as soon as possible by whichever surgeon recieves the patient with whatever facilities he has. Ideally most vitreous surgeon would carry out the substantive vitreous surgery between the 7^thand 14^th day of the injury.There are several surgico-pathological reasons why this is preferred. Besides there are other associated factors,which favour the late interventions. For instance , the trauma to the eye is often a small part of serious, life threatening trauma to the head or chest,which would get priority. However,there are some over riding factors,which calls for early or immediate vitreous surgery. To name a few:retained intraocular foreign body specially those of copper,iron or vegetable matter carrying high risk of infection,in the presence of intraocular

Infection or impending infection. Some surgeon report better results in routine early surgery. Since most open globe injuries calling for surgical intervention are unatural and often present as an emergency or urgent situation there arise several medicolegal considerations,which need to be fully appreciated. Early attention, basic minimum investigation, first aid measures,timely referral to a better equipped surgeon and notifying the law when foul play is suspected are some of considerations.

All magnetic and non magnetic foreign bodies should be removed by parsplana vitrectomy. The prognosis for better vision has improved tremendously by modern technique and instrumentation such as endolaser,vitreous shaver,long term gas or silicone oil tamponade and better visualisation. Indirect ophthalmoscopy is the best method in clear media but CT scan and ultrasonography are the methods of choice to localise the foreign body in hazy media.Several factors have to be considered including the time of surgery,whether one step or two steps, the type of surgical intervention and use of proper intravitreal antibiotics, ifthere is any clinical sign of endophthalmitis.The final prognosis and complications depend not only on the nature of injury, the type of intraocular foreign body but also complications involved in the surgical procedure.

Retina is a unique tissue which can be viewed directly and with unparalleld clarity in the living eye. In case of a pathology with opaque ocular media, we need different techniques for the detection differentiation and follow up of both intraocular and orbital disorders. These diagnostic techniques are:

1. Ophthalmic Ultrasonography; It is indicated whenever partial or complete opacification of media prevents an adequate clinical examination of either anterior or posterior segment.
2. Indirect measure of visual function behind media opacities may be obtained with pupillary light reflex, electroretinography and with visually evoked potential.
3. Fundus photography,fluorescein angiography and ICG have proven to be extremely valuable in the diagnosis and monitoring of the treatment of retinal vascular and macular diseases and also choroidal disorders.
4. Automated perimetry has provided a new technology for visual screening, management of certain neuro ophthalmologic and posterior segment disorders.

The most common manifestations of ocular lens trauma are 1-cataract, 2-subluxation,3-dislocation. The availability of operating microscope and the vitreous cutter have revolutionised the management of ocular trauma. Lensectomy is almost never performed during primary repair. Early surgical intervention may be required in anterior dislocation of lens (limbal approach) or a pars plana approach may become necessary in posterior dislocation with inflammation or secondary glaucoma.Vitrectomy instrumentation is absolutely essential for the management of most lens trauma cases. Lens vitreous admixture in the AC for example is the situation which most anterior segment surgeons can easily manage provided they have vitrectomy instrumentation.

Performing vitreoretinal surgery is like managing articles in a closed room through key holes. The vitreoretinal maneuvers require a brilliant illumination, wide view inside and array of precision micro instruments coupled with dexterity and super skill of vitreoretinal surgeon. There has been constant evolution in techniques and instrumentation for vitreoretinal surgery from a single port multifunction rotary cutter to four port sclerotomy with multiport illumination system,wide angle observation contact or noncontact systems, mechanised fluid gas/oil exchange modules,20-25 gauge variable port curved and straight cutters, laser cutters vitreous surgery machines with ultra fast cutting rate with better fluidics and aspiration pumps. All these advancement in instrumentation and techniques have enabled us to approach sacred areas of retina and vitreous unthinkable only a decade ago. The talk highlights the basic and the advances in four sub sections .a-Vitrectomy machine basic module pump design,mechanics of suction cutters. b-illumination system. C-various observation system. d-micro surgery scissors,forceps,pics,spatula and other accessories.

Ocular trauma contributes to 17% to 40% of all cases of culture positive endophthalmitis and the incidence of endophthalmitis following ocular trauma varies from 2% to 7%. This increased risk is because most trauma occur in unsterile conditions and by contaminated objects. This is particularly so in cases of perforating injuries by vegetable matter and wherein a foreign body lodges itself within the eye. While the former is more likely to produce a fungal endophthalmitis, bacterial species are the usual cause in the latter. The reported mean interval from injury to the onset of endophthalmitis is about 1-2 days in fulminant cases caused by Bacillus cereus and Streptococci, 3-4 days in acute cases caused by S.epidermides and gram negative organisms and about 4-6 weeks for chronic endophthalmitis caused by fungi. The over all profile of organisms isolated from post traumatic endophthalmitis is similar to that in post surgical endophthalmitis with Staphylococcus epidermidis being the commonest.

An important difference is the presence of Bacillus cereus related endophthalmitis in a large number of cases(22%) following trauma.This organism has never been isolated in Post surgical endophthalmitis.Another observable difference is the relative absence of infection caused by yeast like fungi.Most fungal infections are caused by filamentus fungi with greater virulence (e.g. Fusarium solanae).Intra Vitreal antibiotics alone have a limited efficacy in post traumatic endophthalmitis and so many such cases need early vitrectomy has been advocated in all cases with a retained IOFB.