Publications by authors named "Laura R Steeples"

23 Publications

  • Page 1 of 1

Ocular Involvement in the Histiocytoses: A Literature Review with an Illustrative Case Series.

Ocul Immunol Inflamm 2021 Oct 12:1-15. Epub 2021 Oct 12.

Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.

: To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexae Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre. Skin lesions with signs including eyelid mass, orbital bone destruction, bizarre keratic precipitates, limbal or iris mass, haemorrhagic anterior uveitis, subretinal lesions of uncertain etiology, ischaemic retinopathy, optic neuropathy, and apparent steroid-resistant inflammations should be comprehensively investigated. Ophthalmic involvement in histiocytosis is rare. Clinical manifestations vary from limited single-organ disease to lethal systemic infiltration or malignancy. Radiology may identify lesions for biopsy. Histology with appropriate markers is essential. Oncology advice may be required.
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http://dx.doi.org/10.1080/09273948.2021.1936566DOI Listing
October 2021

Intravitreal Fluocinolone 0.19mg Implant in the Management of Chronic Non-Infectious Uveitis: 12-Month Outcomes from a Single Tertiary Centre.

Ocul Immunol Inflamm 2021 Jun 14:1-7. Epub 2021 Jun 14.

Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

Aim: To present efficacy and safety of 0.19 mg fluocinolone acetonide insert (FAi) to treat chronic noninfectious uveitis (NIU) in a single referral center.

Methods: A retrospective observational clinical study of 11 eyes with NIU complicated by chronic cystoid macular edema (CMO).

Results: The main indication for treatment was chronic CMO in all 11 eyes. The mean central retinal thickness (CRT) at baseline was 435 μm ± 176, improving to 296 μm ± 67 at 12 months. Raised intraocular pressure (IOP) was the commonest adverse event. An IOP >21 mmHg was observed in three eyes, and >30 mmHg in one eye, managed with topical therapy. The mean best corrected visual acuity (BCVA) was stable at 12 months. There were no observed recurrences of uveitis. Two eyes received adjunctive treatment for worsening CRT.

Conclusions: Our results suggest FAi is an effective maintenance treatment for NIU with favorable functional and anatomical outcomes.
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http://dx.doi.org/10.1080/09273948.2021.1922707DOI Listing
June 2021

Evaluating the Safety, Efficacy and Patient Acceptability of Intravitreal Fluocinolone Acetonide (0.2mcg/Day) Implant in the Treatment of Non-Infectious Uveitis Affecting the Posterior Segment.

Clin Ophthalmol 2021 7;15:1433-1442. Epub 2021 Apr 7.

Ophthalmology Department, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.

Long-acting, slow-release injectable fluocinolone intravitreal implants have been approved for the treatment of non-infectious uveitis affecting the posterior segment. We summarise the development of intravitreal fluocinolone implants and discuss the technology including pharmacokinetics. We conducted a systematic review of evidence for the efficacy, safety and patient acceptability of fluocinolone 0.18 mg and 0.19 mg injectable implants. We summarise evidence from the pivotal phase 3 studies that lead to the approval of these implants and evaluate real-world including disease-specific evidence. Safety including injection-related events and long-term adverse events is presented.
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http://dx.doi.org/10.2147/OPTH.S216912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039205PMC
April 2021

Avascular Necrosis of Bone in Patients with Uveitis Treated with Systemic Corticosteroids.

Ocul Immunol Inflamm 2021 Feb 4:1-7. Epub 2021 Feb 4.

Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.

: To identify the prevalence, risk factors and outcomes of avascular necrosis (AVN) in patients with chronic uveitis.: A retrospective study of patients with corticosteroid-induced AVN treated at Manchester Uveitis Clinic between 1991 and 2019.: From a cohort of 4478 patients, 1698 had been treated with systemic corticosteroids. Five patients with AVN were identified (prevalence 0.29%). The mean age at diagnosis of AVN was 49 years. All 5 patients were using systemic immunosuppression. Four patients developed femoral head AVN in 7 joints, one had bilateral knee osteonecrosis. The mean duration of corticosteroid before AVN was 38 months; the mean dose at onset was 17mg/day and the mean cumulative dose was 18,860mg. Three patients required total hip replacements but management was conservative for others. There was no permanent disability.: AVN is a rare but severe complication of corticosteroid therapy. Clinicians should be vigilant for symptoms of bone pain as early detection and cessation of corticosteroids can reverse incipient AVN and avoid surgery.
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http://dx.doi.org/10.1080/09273948.2020.1844903DOI Listing
February 2021

Intra and inter-rater agreement of inflammatory choroidal neovascular membrane measurements using optical coherence tomography angiography.

Graefes Arch Clin Exp Ophthalmol 2020 Mar 19;258(3):647-651. Epub 2019 Dec 19.

Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.

Purpose: Automated measurement algorithm software is not routinely available in optical coherence tomography angiography (OCTA) devices and manual measurement of choroidal neovascular membrane (CNVM) size is necessary. Our aim was to determine intra- and inter-rater agreement of inflammatory CNVM manual measurements obtained with OCTA.

Methods: OCTA (Triton® Topcon Corporation) images in patients with inflammatory CNVM were imported into ImageJ software v1.50 (NIH image). Two experienced observers performed manual area and perimeter measurements independently, and one of the observers performed the same measurements twice. Agreement was evaluated with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). Bland-Altman plots were plotted to graphically assess concordance. Statistical analysis was performed using STATA v13.0.

Results: Sixteen eyes of 16 subjects, with a mean age of 39.0 ± 16.6 years (range 13-71), were included. Mean CNVM area and perimeter was 124.83 ± 117.80 and 4.20 ± 2.00 mm, respectively. Intra-rater ICC for both area and perimeter measured was 0.99 (95% confidence interval (CI) 0.99-0.99). Inter-rater ICC for area and perimeter measured was 0.95 (95%CI 0.87-0.98) and 0.81 (95%CI 0.17-0.94), respectively. Intra-rater CCC for both area and perimeter measured was 0.99 (95%CI 0.99-0.99). Inter-rater CCC for both area and perimeter measured was 0.91 (95%CI 0.81-0.99) and 0.66 (95%CI 0.44-0.88), respectively.

Conclusions: Inflammatory CNVM manual measurement showed high intra-rater agreement and moderate inter-rater agreement. Repeatability and reproducibility studies are essential in manual analysis to establish thresholds that can distinguish measurements variation from true clinical change. An automatic algorithm may be helpful to accurately grade lesions and monitor disease activity and response to treatment.
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http://dx.doi.org/10.1007/s00417-019-04538-1DOI Listing
March 2020

Tubulointerstitial nephritis and uveitis (TINU) syndrome: a review.

Br J Ophthalmol 2020 06 12;104(6):742-747. Epub 2019 Nov 12.

Centro de Estudos das Ciências da Visão, Faculdade de Medicina de Lisboa, Lisboa, Portugal

Inflammation of renal interstitium and uveal tissue establishes the two components of tubulointerstitial nephritis and uveitis (TINU) syndrome. Although believed to occur more frequently in young females, a broad spectrum of patients can be affected. Both renal and eye disease can be asymptomatic and may not manifest simultaneously, having independent progressions. Renal disease manifests as acute kidney injury and may cause permanent renal impairment. Eye inflammation can manifest in different anatomical forms, most commonly as bilateral anterior uveitis and may progress to a chronic course. TINU syndrome accounts for approximately 1%-2% of uveitis in tertiary referral centres. A literature review covering the clinical features, pathogenesis, diagnosis and treatment is presented.
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http://dx.doi.org/10.1136/bjophthalmol-2019-314926DOI Listing
June 2020

Atypical Ocular Toxoplasmosis During Adalimumab Anti-Tumor Necrosis Factor Therapy for Rheumatoid Arthritis.

J Clin Rheumatol 2020 Dec;26(8):e279-e280

Ophthalmology, Bolton NHS Trust, Bolton Greater Manchester, United Kingdom.

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http://dx.doi.org/10.1097/RHU.0000000000001124DOI Listing
December 2020

Miliary tuberculosis developing during adalimumab treatment for Behçet's disease with uveitis.

BMJ Case Rep 2018 Dec 4;11(1). Epub 2018 Dec 4.

Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.

Tumour necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine in non-infective uveitis (NIU). Adalimumab, an anti-TNF-α monoclonal antibody, is approved for the treatment of severe NIU by the European Medicines Agency. There is a recognised risk of serious infections, including tuberculosis (TB), during anti-TNF-α therapy in systemic immune-mediated diseases. We describe miliary pulmonary TB during adalimumab therapy for severe NIU. To our knowledge, this is the first detailed report of this complication in a patient with uveitis. We present the challenges of managing vision-threatening uveitis during life-threatening infection necessitating withdrawal of adalimumab and oral immunosuppression therapy. Uveitis activity was controlled during anti-TB therapy with oral corticosteroid therapy.
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http://dx.doi.org/10.1136/bcr-2018-226772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301654PMC
December 2018

Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management: A Comparative Laboratory Study.

J Curr Glaucoma Pract 2018 May-Aug;12(2):64-66. Epub 2018 Aug 1.

Consultant and Surgeon, Aintree University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, UK.

Aim: Concerns regarding 5-Fluorouracil (5-FU) corneal toxicity have resulted in various ways of reducing its corneal exposure during post-operative trabeculectomy bleb manipulation. This study investigates the properties of various topical agents used to induce the precipitation of this compound.

Materials And Methods: This is a double-blind, descriptive, laboratory study comparing five different potential precipitants of 5-FU (proxymetacaine (proxy), oxybuprocaine (oxy), ametho-caine (ameth), fluorescein (flor), proxymetacaine + fluorescein (proxy-flor) to a control group (normal saline). A 0.01 mL of each anonymized agent was applied next to a clear round comparison marker in a transparent sterile container set on a dark background. 5-FU (0.01 mL of 50 mg/mL) was subsequently applied to each agent. The induced changes in transparency were imaged and compared to the transparency of the central marker. For each application, pH changes were also noted.

Results: Proxy, flor and proxy + flor did not result in any discernible 5-FU precipitation. Oxy resulted in a moderate visible change, and ameth produced very significant precipitation. Application of proxy, oxy, ameth, and proxy + flor resulted in the neutralization of the 5-FU's alkaline pH.

Conclusion: We propose using a cotton-tipped bud dipped in ameth applied at the injection site as the recommended method to avoid 5-FU corneal exposure in these cases.

Clinical Significance: Practitioners should be aware of the differences in precipitation of 5-FU by different types of topical anesthetics and modify techniques of anesthesia and 5-FU administration accordingly. Mercieca KJ, Fenerty CH, Steeples LR, Drury B, Bhargava A. Precipitants of 5-Fluorouracil in Trabeculectomy Bleb Management : A Comparative Laboratory StudyJ Curr Glaucoma Pract 2018;12(2):64-66.
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http://dx.doi.org/10.5005/jp-journals-10008-1247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236122PMC
August 2018

An unusual case report of primary vitreoretinal lymphoma.

BMC Ophthalmol 2018 Sep 14;18(Suppl 1):223. Epub 2018 Sep 14.

Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, Medicine and Health, University of Manchester, Manchester, UK.

Background: Primary vitreoretinal lymphoma (PVRL) is a rare ocular condition and its diagnosis remains a challenge. The clinical presentation is variable and it can masquerade as chronic intermediate or posterior uveitis. We report an unusual case of primary central nervous system lymphoma (PCNSL) presenting as migrating retinal lesions with unique shapes. The diagnostic challenges are described and the clinical features of intraocular lymphoma are reviewed.

Case Presentation: A 53 year-old gentleman presented with unilateral visual disturbance and a wide area of retinal whitening with sharp borders temporal to the macula, corresponding to hyper-reflective subretinal changes on optical coherence tomography (OCT). The lesion resolved spontaneously after 6 weeks but was replaced by multiple punctate sub-retinal and sub-retinal pigment epithelial lesions. The second eye was involved 4 months later and there were new areas of hyper-reflective changes in both eyes, which migrated nasally within a week, with no evidence of scarring in the previous sites. The diagnosis of diffuse B-cell lymphoma was made on brain biopsy when the patient subsequently presented with acute confusion and magnetic resonance imaging brain scan showed a frontal lesion. Following systemic chemotherapy, the sub-retinal changes resolved with complete restoration of retinal architecture and improvement in visual acuity.

Conclusion: We report an unusual case of PVRL presenting as migrating retinal lesions with unique shapes. PVRL is a great imitator and a high index of clinical suspicion is required in unexplained ocular lesions to prevent a delay in diagnosis.
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http://dx.doi.org/10.1186/s12886-018-0860-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156902PMC
September 2018

Clinical spectrum of vitreoretinal lymphoma and its association with MyD88 L265P mutation.

Acta Ophthalmol 2019 Feb 16;97(1):e138-e139. Epub 2018 Aug 16.

Pathology Department, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

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http://dx.doi.org/10.1111/aos.13808DOI Listing
February 2019

Multimodal Evaluation of Presumed Tuberculous Serpiginous-Like Choroiditis.

Ocul Immunol Inflamm 2019 6;27(7):1149-1153. Epub 2018 Aug 6.

Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester , Manchester , UK.

: To evaluate multimodal imaging findings in longitudinal follow-up of a patient with presumed tuberculous serpiginous-like choroiditis (TB-SLC). : We evaluated multimodal imaging in a 62-year-old male with TB-SLC. Correlation between optical coherence tomography angiography (OCTA), swept-source OCT (SS-OCT) and fundus autofluorescence (FAF) at defined disease stages and evolution of observed imaging descriptors during long-term follow-up has not been previously reported. : OCTA of the active lesion demonstrated defined areas of choriocapillaris hypoperfusion, suggesting inflammatory vascular occlusive pathology. Over 9-month follow-up, OCTA illustrated sequential improvement in choriocapillaris flow, suggesting vascular remodeling. This correlated with progressive change in FAF signal and transition to diffuse hypoautofluorescence. SS-OCT demonstrated focal choroidal thickening and retinal pigment epithelium elevation in acute phase and resolution in time. : Multimodal imaging, particularly novel non-invasive technologies such as OCTA and SS-OCT, improves our understanding of the pathogenesis and evolution of disease in TB-SLC.
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http://dx.doi.org/10.1080/09273948.2018.1501497DOI Listing
April 2020

Incidence, management and outcome of raised intraocular pressure in childhood-onset uveitis at a tertiary referral centre.

Br J Ophthalmol 2019 06 18;103(6):748-752. Epub 2018 Jul 18.

Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.

Background/aims: To investigate the incidence, management and outcome of uveitis and raised intraocular pressure (IOP) in children treated at the Manchester Uveitis Clinic (MUC).

Methods: This was a retrospective, observational study of patients who presented with uveitis under the age of 16 to the MUC from July 2002 to June 2016.

Results: A total of 320 children were included in the study. Out of these, 55 (17.2%) patients (75 eyes) were found to have raised IOP requiring treatment. The mean age at diagnosis of uveitis and at first recorded raised IOP was 8.2±4.3 and 10.8±3.6 years, respectively. The pre-treatment IOP was 32.3±6.6 mm Hg and the IOP at the final visit was 15.5±3.7 mm Hg (median follow-up period, 43.7 months) on a median number of 0 medications. Twenty-eight eyes (37.3%) required glaucoma drainage surgery, and eight eyes (12.5%) had cyclodiode laser before this. Kaplan-Meier analysis showed that 11.5% of eyes required glaucoma surgery at 1 year after diagnosis of raised IOP, increasing to 50.0% by 5 years. The best-corrected visual acuity at diagnosis of uveitis was 0.26±0.42 logMAR, which remained stable at 0.28±0.65 logMAR at final follow-up visit. Four eyes (5.3%) from four patients fulfilled the definition of blindness by the WHO criteria. The mean cup:disc ratio at final follow-up was 0.4.

Conclusion: Our cohort of children with raised IOP appeared to have a good outcome overall through aggressive medical and surgical management. Regular long-term follow-up is recommended, and early surgical intervention in eyes with uncontrolled IOP can prevent loss of vision.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312498DOI Listing
June 2019

Atypical sarcoidosis-associated uveitis: diagnostic challenges.

BMJ Case Rep 2018 May 30;2018. Epub 2018 May 30.

Ophthalmology, Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.

Sarcoidosis is a multisystem disease of unknown aetiology with pulmonary involvement in most patients. Uveitis is common and often characteristic. We report a case of ocular sarcoidosis with grossly atypical contiguous optic neuropathy and choroiditis and describe the diagnostic challenges in this highly unusual presentation. High-dose systemic corticosteroid and immunosuppressive treatment was required for sustained control of intraocular inflammation.
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http://dx.doi.org/10.1136/bcr-2018-225137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976088PMC
May 2018

Adalimumab in refractory cystoid macular edema associated with birdshot chorioretinopathy.

Int Ophthalmol 2018 Jun 12;38(3):1357-1362. Epub 2017 Jun 12.

Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Lower Maudlin Street, Bristol, BS1 2LX, UK.

Purpose: To report the clinical outcomes of adalimumab therapy in cases of birdshot chorioretinitis (BCR) with cystoid macular edema (CME) refractory to conventional immunotherapy.

Methods: This is a retrospective case series of three BCR patients treated with adalimumab for refractory CME. The main outcome measure was central subfield thickness (CST) on optical coherence tomography. Any patients treated with local steroids and/or receiving systemic steroids higher than 40 mg prednisolone daily during adalimumab therapy were excluded.

Results: At baseline, all patients were receiving systemic corticosteroids and two second-line immunosuppressive agents. The mean duration of treatment with adalimumab was 31.2 months (range 17.2-52). The mean CST was 327 ± 112.7 μm (mean ± SD) at baseline and 256.2 ± 39.7 μm at 6 months and 235.5 ± 32.5 μm at 12 months. Adalimumab permitted cessation or reduction in the daily dose of oral prednisolone plus withdrawal of a second-line agent in all patients.

Conclusions: In these patients, adalimumab was effective in the treatment of refractory CME.
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http://dx.doi.org/10.1007/s10792-017-0592-5DOI Listing
June 2018

Full-thickness macular hole: a rare complication of neuroretinitis.

BMJ Case Rep 2017 May 3;2017. Epub 2017 May 3.

Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK.

is a known infective cause of neuroretinitis. We present a case of neuroretinitis complicated by macular hole in a 22-year-old man. The neuroretinitis was managed with early high-dose intravenous corticosteroid and oral antibiotic. The macular hole was managed with macular hole surgery after intraocular inflammation had resolved.
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http://dx.doi.org/10.1136/bcr-2016-219019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747600PMC
May 2017

Clinical Outcomes of Intravitreal Preservative-Free Triamcinolone Preparation (Triesence®) for Cystoid Macular Oedema and Inflammation in Patients with Uveitis.

Ocul Immunol Inflamm 2018 20;26(7):997-1004. Epub 2017 Mar 20.

a Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK.

Purpose: To assess the outcomes of intravitreal benzyl alcohol-free triamcinolone acetonide suspension in uveitis-related macular oedema.

Methods: Single-center retrospective cohort study of 66 injections to 44 eyes of 40 patients. Uveitis diagnosis, systemic and local therapy, intraocular pressure (IOP), central retinal thickness (CRT), number of injections, time to re-injection and side-effects were noted during 6-months minimum follow-up.

Results: Sixty eight percent of eyes received a single injection. 18% required 2 injections, and 13% received ≥3 injections with mean time to second and third injections of 25.5 and 52.7 weeks, respectively. 90% of injections were unilateral. Mean CRT reduced, and by 12-weeks visual acuity improvement >0.3logMar was achieved in 46%. Cataract progression (47%) and IOP>21 mmHg (45%) were the commonest adverse events.

Conclusion: Preservative-free triamcinolone is an additional option for uveitis-related macular oedema, particularly in unilateral cases, with favorable CRT and visual outcomes. Repeat injections may be necessary, and the period of efficacy varies between eyes.
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http://dx.doi.org/10.1080/09273948.2017.1294185DOI Listing
December 2018

Multimodal Imaging in Acute Posterior Multifocal Placoid Pigment Epitheliopathy Demonstrating Obstruction of the Choriocapillaris.

Ophthalmic Surg Lasers Imaging Retina 2016 07;47(7):677-81

Optical coherence tomography angiography (OCTA) provides noninvasive in vivo vascular imaging of the retina and choriocapillaris. To highlight OCTA utility, the authors align structural changes and their resolution with functional outcome. The authors present a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and sequential changes during transition to inactive disease. In the acute phase, altered flow and nonperfusion were seen in defined islands of choriocapillaris. Over time, progressive reperfusion was observed and accompanied clinical resolution and functional visual restoration. The imaging features acquired described the level of nonperfusion the authors had assumed when extrapolating findings from multiple independent imaging modalities. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:677-681.].
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http://dx.doi.org/10.3928/23258160-20160707-12DOI Listing
July 2016

Multifocal chorioretinitis with progressive subretinal fibrosis in a young child.

BMJ Case Rep 2015 Oct 14;2015. Epub 2015 Oct 14.

Manchester Royal Eye Hospital, Manchester, UK.

Progressive subretinal fibrosis with uveitis (PSFU) syndrome is a rare clinical entity presenting with multifocal granulomatous chorioretinitis and subsequently developing extensive subretinal fibrosis over weeks or months. Subretinal fibrosis affecting the macula may cause profound and permanent vision loss. We report the presentation and management of this condition in a child, to our knowledge, the youngest reported. The condition caused substantial visual loss and required high-dose systemic corticosteroid and immunosuppression with methotrexate and ciclosporin to control aggressive intraocular inflammation.
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http://dx.doi.org/10.1136/bcr-2015-212526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612310PMC
October 2015

Real-time PCR using the 529 bp repeat element for the diagnosis of atypical ocular toxoplasmosis.

Br J Ophthalmol 2016 Feb 14;100(2):200-3. Epub 2015 Jul 14.

Manchester Royal Eye Hospital, Manchester, UK.

Background: Ocular toxoplasmosis may present in atypical fashion, particularly in immunosuppressed patients, and PCR is an important diagnostic tool especially when differentiating from other infectious causes.

Methods: A descriptive case-series demonstrating the use of a novel real-time PCR protocol targeting 529 bp repeat element, a multicopy and highly conserved fragment, in Toxoplasma gondii genome. This was designed and established by our microbiology service following independent, external validation.

Results: Three immunosuppressed patients presenting to a tertiary uveitis referral centre with unilateral, severe, sight-threatening uveitis are described. One patient presented with a large focus of sight-threatening retinitis and occlusive vasculitis while on systemic immunosuppression with azathioprine and adalimumab for Crohn's disease. One patient with chronic lymphocytic leukaemia presented with severe posterior uveitis and total retinal detachment. Finally, the third patient presented with severe retinitis adjacent to the optic nerve and vitritis causing acute vision loss. HIV infection was subsequently identified. In all three cases, the cause of inflammation was not clear from clinical examination alone and prompt treatment was required to prevent permanent vision loss. Intraocular sampling and PCR testing was performed including testing for toxoplasmosis, herpesviruses and syphilis.

Conclusions: The novel real-time PCR assay described is more sensitive than those targeting the Toxoplasma B1 gene owing to the higher number of repeats and highly conserved sequence level. This technique can be applied in clinical practice and provides a valuable tool for the rapid diagnosis of ocular toxoplasmosis.
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http://dx.doi.org/10.1136/bjophthalmol-2015-306801DOI Listing
February 2016

Late in-the-bag intraocular lens dislocation in patients with uveitis.

Br J Ophthalmol 2015 Sep 11;99(9):1206-10. Epub 2015 Mar 11.

Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.

Background: Late in-the-bag intraocular lens (IOL) dislocation is an unusual complication of cataract surgery, being strongly associated with pseudoexfoliation, less so with previous vitreoretinal surgery, myopia and uveitis. We present the clinical features, management and outcomes of late spontaneous IOL dislocation in a series of patients with uveitis.

Methods: A retrospective case series of IOL dislocation affecting patients in the Manchester Uveitis Clinic, UK. The uveitis diagnosis, IOL type, presentation and management are discussed.

Results: Six patients from out of 1056 undergoing cataract surgery (0.57%) were affected. Uveitis was the only identified risk factor for IOL dislocation, which occurred a mean 10.3 years following uncomplicated cataract surgery by phakoemulsification with endocapsular IOL implantation. The dislocation was in-the-bag in all six cases. Two patients presented with the IOL in the anterior chamber, and required removal of the IOL-bag complex, and are using aphakic refractive correction. Two patients with inferior IOL subluxation have been managed conservatively. Two patients underwent pars plana vitrectomy with sutureless scleral fixation of the existing IOL in one case, and IOL exchange with a scleral sutured IOL in the other.

Conclusions: IOL dislocation is an uncommon late complication in patients with uveitis. Conservative management is appropriate in patients with tolerable symptoms, or in those with difficult uveitis. Otherwise, fixation of the existing IOL, or removal and implantation of a secondary IOL, may be necessary. Angle-supported, or iris-enclaved IOLs, are not of proven safety in this patient group; scleral-fixated posterior chamber IOLs are the favoured approach in our service.
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http://dx.doi.org/10.1136/bjophthalmol-2014-306437DOI Listing
September 2015
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