Publications by authors named "Nicholas P Jones"

31 Publications

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2021.1936566DOI Listing
October 2021

Temperature stress and disease drives the extirpation of the threatened pillar coral, Dendrogyra cylindrus, in southeast Florida.

Sci Rep 2021 07 8;11(1):14113. Epub 2021 Jul 8.

Nova Southeastern University, Halmos College of Arts and Sciences, Dania Beach, FL, USA.

Rare species population dynamics can elucidate the resilience of an ecosystem. On coral reefs, climate change and local anthropogenic stressors are threatening stony coral persistence, increasing the need to assess vulnerable species locally. Here, we monitored the threatened pillar coral, Dendrogyra cylindrus, population in southeast Florida, USA, in relation to consecutive heat stress events in 2014 and 2015. In the fall of each year, D. cylindrus colonies bleached following intense thermal stress and by June 2020 all monitored colonies died from a white-syndrome type disease. This resulted in the ecological extinction of D. cylindrus in the Southeast Florida Coral Reef Ecosystem Conservation Area (ECA). White-syndrome type disease was first seen in February 2014 on four colonies (19% prevalence) near the major international port, Port Everglades and disease prevalence peaked in fall 2015 (58%). Disease prevalence increased with maximum water temperature, while disease related mortality increased with mean water temperature. Our findings suggest that thermal stress exacerbated underlying stony coral disease, resulting in an outbreak contributing to the ecological extirpation of D. cylindrus in the ECA. We suggest that stony coral resilience is severely compromised by chronic environmental disturbance which hinders community recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-93111-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266880PMC
July 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2021.1922707DOI Listing
June 2021

Consensus Recommendations for the Diagnosis of Vitreoretinal Lymphoma.

Ocul Immunol Inflamm 2021 Apr 19;29(3):507-520. Epub 2021 May 19.

Eye and Vision Health section, Flinders University College of Medicine and Public Health, Adelaide, Australia.

Purpose: To provide recommendations for diagnosis of vitreoretinal lymphoma (VRL).

Methods: Literature was reviewed for reports supporting the diagnosis of VRL. A questionnaire (Delphi 1 round) was distributed to 28 participants. In the second round (Delphi 2), items of the questionnaire not reaching consensus (75% agreement) were discussed to finalize the recommendations.

Results: Presenting symptoms include floaters and painless loss of vision, vitreous cells organized into sheets or clumps. Retinal lesions are usually multifocal creamy/white in the outer retina. Other findings include retinal lesions with "leopard-skin" appearance and retinal pigment epithelium atrophy. Severe vitreous infiltration without macular edema is the most likely presentation. Diagnostic vitrectomy should be performed. Systemic corticosteroid should be discontinued at least 2 weeks before surgery. An interleukin (IL)-10:IL-6 ratio > 1, positive mutation for the myeloid differentiation primary response 88 gene and monoclonality are indicators of VRL. Multi-modal imaging (optical coherence tomography, fundus autofluorescence) are recommended.

Conclusions: A consensus meeting allowed the establishment of recommendations important for the diagnosis of VRL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2021.1878233DOI Listing
April 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2020.1844903DOI Listing
February 2021

Corneal Decompensation in Uveitis Patients: Incidence, Etiology, and Outcome.

Ocul Immunol Inflamm 2021 May 6;29(4):771-775. Epub 2020 Jan 6.

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

: To identify the prevalence, etiology, management and visual outcomes of treatment in uveitis-related corneal decompensation.: This is a retrospective study of patients with corneal decompensation identified from a large cohort with uveitis in a tertiary referral clinic setting.: Between March 1991 and May 2018, 4132 new patients with uveitis were seen in Manchester Uveitis Clinic. Of these, 25 patients (0.6%) were identified with corneal decompensation of which 9 (0.2%) were affected bilaterally (total 34 eyes). The mean interval between uveitis diagnosis and decompensation was 23 months (range 0-117 m). Ten patients (41%) had associated glaucoma. Seventeen eyes (50%) had undergone intraocular surgery prior to decompensation. For eyes with no history of raised intraocular pressure or intraocular surgery, keratouveitis (presumed autoimmune or tuberculous) was the most common cause of corneal decompensation. Fourteen eyes (41%) required corneal graft and of these, five required repeat grafting.: Corneal decompensation in eyes with uveitis is a rare but significant complication. Direct endothelial inflammation may alone cause decompensation, but in most eyes with uveitis, prior raised intraocular pressure or intraocular surgery are required to precipitate the cornea into decompensation. Outcomes of corneal transplantation in this group may be disappointing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1698747DOI Listing
May 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-019-04538-1DOI Listing
March 2020

Urgent Management of Secondary Glaucoma in Uveitis Using the Xen-45 Gel Stent.

J Glaucoma 2019 12;28(12):1061-1066

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

Precis: The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required.

Purpose: The purpose of this study was to report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis.

Methods: Retrospective observational case series of 37 eyes, with medically uncontrolled glaucoma in uveitis using Xen-45 implantation. All patients had at least 12 months follow-up. Primary outcome measures included visual acuity, intraocular pressure (IOP), degree of inflammation and ocular hypotensive medications. In addition, the time taken from the decision to surgery was recorded. Data were collected preoperatively and 1 day, 1 week, 1, 3, 6, and 12 months postoperatively. Postoperative complications included hypotony and decompressive retinopathy. The requirement for further glaucoma surgery, including bleb needling, and failure were documented.

Results: The mean follow-up time was 16.7 months (range: 12 to 32 mo). Preoperatively all patients were on >3 ocular hypotensive medications and 75.7% were on oral acetazolamide. Systemic immunosuppression was used in 62.2% and all were on topical steroids. Mean preoperative IOP was 36.1 mm Hg (±SD 9.6) on an average 3.69 (±SD 0.47) drops. The median time from decision to operate to surgery was 5.5 days (range: 1 to 120 d). Mean postoperative IOP was 12.6 mm Hg (±SD 4.1) with an average 0.62 (±SD 1.1) drops at 1 year representing a 65% drop in IOP and 83% reduction in IOP-lowering medication. Bleb needling with 5-fluorouracil was performed on 5 eyes (13.5%). Symptomatic hypotony occurred in 7 eyes requiring further interventions. No decompressive retinopathy was found at last follow-up. Five eyes (13.5%) failed, needing drainage tube surgery or trabeculectomy.

Conclusions: The Xen-45 implant is an effective treatment for hypertensive crises in glaucoma in uveitis, offering dramatic IOP lowering without significant uveitis flare-up. In this group of patients with uveitis, needling rates are lower than reported in primary open-angle glaucoma. However, complications including hypotony can still occur.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001389DOI Listing
December 2019

Immunosuppression in the Management of Presumed Non-infective Uveitis; Are We Sure What We are Treating? Notes on the Antimicrobial Properties of the Systemic Immunosuppressants.

Authors:
Nicholas P Jones

Ocul Immunol Inflamm 2020 Aug 16;28(6):994-1003. Epub 2019 Aug 16.

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

Purpose: To describe the antimicrobial effects of immunosuppressants used for presumed autoimmune uveitis, and to discuss the potential importance of these effects in the context of increasing knowledge of the human microbiomes and their influence on inflammation.

Methods: Literature review.

Review Of Evidence: All immunosuppressants have intrinsic antimicrobial effects; these vary considerably between drugs, and include antibacterial, antiviral and antifungal action. Immunosuppression is known to affect the composition of the gut microbiome, and alterations in microbiome composition are known to affect inflammations including uveitis.

Conclusions: Oral immunosuppressants are assumed to act on presumed autoimmune uveitis by downregulation of, or other interference with, an aberrant immune response. However, their antimicrobial properties are usually forgotten, and in the context of increasing knowledge of the involvement of microbes in the initiation of, and also potentially the perpetuation of, tissue inflammation, these effects may prove to be a fundamental part of their action.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2019.1643030DOI Listing
August 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.

View Article and Find Full Text PDF

Download full-text PDF

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

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12886-018-0860-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6156902PMC
September 2018

Long-Term Outcomes and Complications of Baerveldt Glaucoma Drainage Implants in Adults with Glaucoma Secondary to Uveitis.

Ocul Immunol Inflamm 2019 13;27(8):1322-1329. Epub 2018 Sep 13.

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

This study investigated the efficacy and safety of Baerveldt glaucoma implants (BGI) in adults with uveitic glaucoma (UG) at the Manchester Uveitis Clinic. This was a retrospective study of 42 patients with UG who underwent BGI implantation between 2006 and 2015. Primary outcome measures were intraocular pressure (IOP) reduction and number of medications at 5-year follow-up. Three IOP success criteria were chosen: 1.IOP ≤21 mmHg and ≥20% reduction from baseline 2.IOP ≤17 mmHg and ≥20% reduction from baseline and 3.IOP ≤14 mmHg. The mean pre-operative IOP was 29.5 ± 9.5 mmHg on 3.9 antiglaucoma drops. At 5-year follow-up, IOP reduced to 14.4 ± 7.0 mmHg ( < 0.005) on 1.4 drops. The cumulative probability of failure at 5 years based on criteria 1, 2, and 3 was 24.3%, 39.6%, and 56.3%, respectively. This study demonstrated that BGI are safe and effective in refractory UG, especially in younger adults with complex uveitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1517892DOI Listing
May 2020

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1501497DOI Listing
April 2020

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2018-225137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976088PMC
May 2018

Certification of Vision Impairment in Patients with Uveitis Attending a Specialist Clinic.

Ocul Immunol Inflamm 2019 15;27(4):540-544. Epub 2018 Mar 15.

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

: To identify the causes of severe visual loss in a UK uveitis clinic, to suggest means of reducing incidence, and to propose improvement in data collection of vision impairment. : Retrospective case series. : Over 128 months, 76 (3.5-4% of patients referred) were certified as vision-impaired or severely vision-impaired. The mean age at registration was 48.4 years, 76% were of working age, and 7% were children. The diagnosis leading most often to registration was sympathetic ophthalmia and the most frequent uveitis complications were secondary cataract (whether or not operated upon) in 62%, chronic cystoid macular edema in 43%, and secondary glaucoma in 28%. Visual loss was often multifactorial. : Severe and permanent visual loss in uveitis affects people predominantly of working age. It is probably underreported and a restructuring of the certificate of vision impairment may improve data collection. Early referral to a tertiary center may reduce the incidence of vision impairment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2018.1441874DOI Listing
December 2019

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09273948.2017.1294185DOI Listing
December 2018

Liver Function Testing Is Not Useful in the Diagnosis of Sarcoidosis in Patients Presenting with Uveitis.

Authors:
Nicholas P Jones

Ocul Immunol Inflamm 2017 Jun 22;25(3):333-337. Epub 2016 Feb 22.

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

Purpose: To elucidate the usefulness of abnormal liver function tests in the diagnosis of sarcoidosis in patients presenting with ocular inflammation.

Methods: Retrospective comparison of sample populations of 100 patients each with sarcoidosis-associated uveitis (SAU) and non-sarcoid uveitis controls.

Results: Number of abnormal results between SAU and control groups were: (1) raised alkaline phosphatase 6:2; (2) raised alanine aminotransferase 21:19; (3) raised total protein 14:5; (4) hypoalbuminemia 0:7; (5) raised bilirubin 1:2. The only parameters reaching statistical significance were in (3), using any elevated result; and (4), the greater risk being in controls.

Conclusions: There is no evidence that abnormal liver function tests are an indicator of sarcoidosis in new patients presenting with uveitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2015.1116589DOI Listing
June 2017

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2014-306437DOI Listing
September 2015

Visual outcomes of pars plana vitrectomy with epiretinal membrane peel in patients with uveitis.

Retina 2015 Apr;35(4):736-41

The University of Manchester, Manchester Academic Health Science Center, Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, United Kingdom.

Purpose: To report the outcomes of pars plana vitrectomy with epiretinal membrane (ERM) peel, with or without internal limiting membrane peel, in patients with uveitis.

Methods: Retrospective interventional case series of patients undergoing pars plana vitrectomy with ERM peel between January 2005 and March 2012. Sixteen consecutive patients (16 eyes) were identified, with a minimum postoperative follow-up of 6 months. Visual acuity, anatomical outcomes, perioperative control of inflammation, and complications were assessed.

Results: The mean age at surgery was 47.3 years (range, 14-68 years), with a mean duration of ERM at surgery of 21.3 months (3-84 months). At 6 months, visual acuity improved in 31.25% of eyes, stabilized in 31.25%, and was worse in 37.5%. The causes of reduced visual acuity postoperatively included severe preexisting macular pathology and unoperated cataract.

Conclusion: Pars plana vitrectomy with ERM peel in eyes with uveitis may improve or stabilize visual acuity, especially in eyes with macular traction, but in the absence of traction, outcomes are variable and unpredictable. Prevention of ERM formation by aggressive control of inflammation is important.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000000378DOI Listing
April 2015

The Manchester Uveitis Clinic: the first 3000 patients--epidemiology and casemix.

Authors:
Nicholas P Jones

Ocul Immunol Inflamm 2015 Apr 2;23(2):118-26. Epub 2013 Dec 2.

The Royal Eye Hospital , Manchester , UK.

Purpose: To demonstrate the demography, anatomical, and diagnostic classification of patients with uveitis attending the Manchester Uveitis Clinic (MUC), a specialist uveitis clinic in the northwest of England, UK.

Methods: Retrospective retrieval of data on a computerized database incorporating all new referrals to MUC from 1991 to 2013.

Results: A total of 3000 new patients with uveitis were seen during a 22-year period. The anatomical types seen were anterior 46%; intermediate 11.1%; posterior 21.8%; and panuveitis 21.1%. The most common diagnoses were Fuchs heterochromic uveitis (11.5% of total), sarcoidosis-related uveitis (9.7%), idiopathic intermediate uveitis (7.9%), idiopathic acute anterior uveitis (7.0%), and toxoplasmosis (6.9%). Syphilis and tuberculosis-associated uveitis increased markedly in frequency during the study period.

Conclusions: The uveitis casemix in this region reflects a predominantly white Caucasian population in a temperate country, but with changing characteristics owing to increasing immigration, enhanced diagnostic techniques, changes in referral pattern, and some real changes in disease incidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2013.855799DOI Listing
April 2015

Polymerase chain reaction testing of vitreous in atypical ocular syphilis.

Ocul Immunol Inflamm 2013 Jun 25;21(3):227-30. Epub 2013 Apr 25.

Purpose: To illustrate the diagnostic importance of syphilis PCR testing on intraocular fluid for atypical presentations.

Methods: Retrospective case series.

Results: Two cases of atypical intraocular inflammation were confirmed by PCR testing of vitreous for Treponema pallidum DNA.

Conclusions: Ocular syphilis may be present in atypical fashion, and delayed treatment may lead to irreversible visual loss. Sampling of intraocular fluid for PCR testing may confirm diagnosis and lead to appropriate treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2013.770887DOI Listing
June 2013

Serpiginous-like choroiditis as a marker for tuberculosis in a non-endemic area.

Br J Ophthalmol 2013 May 28;97(5):644-7. Epub 2013 Feb 28.

Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WL, UK.

Aim: To describe the increasing incidence of multifocal outer retinal and inner choroidal inflammation as a marker for intraocular tuberculosis in the UK, a non-endemic area.

Patients And Methods: Retrospective case series.

Results: 14 patients presented with serpiginous-like choroiditis over 10 years (seven within the last 2 years). Seven of 14 patients showed evidence of exposure to tuberculosis and received antituberculous treatment. 17 of 23 eyes showed stable or improved visual acuity. All with decreased acuity had direct macular involvement at presentation.

Conclusions: Multifocal outer retinal and inner choroidal inflammation is a marker for intraocular tuberculosis of increasing importance, even in a non-endemic area. Originally described as 'serpiginous-like choroiditis', the lesions are multifocal, irregular in shape, very numerous, widespread, often asymmetrical and often demonstrating both active and resolved lesions simultaneously. Active lesions show contiguous extension. We recommend that every patient with SLC should undergo testing for previous exposure to tuberculosis, and undergo antituberculous treatment if lesions are progressive and sight-threatening.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2012-302918DOI Listing
May 2013

Outcomes and complications of trabeculectomy enhanced with 5-fluorouracil in adults with glaucoma secondary to uveitis.

J Glaucoma 2013 Oct-Nov;22(8):663-6

Manchester Royal Eye Hospital, Oxford Road, Manchester, UK.

Purpose: To analyze the long-term clinical outcomes of 5-fluorouracil (5FU)-enhanced trabeculectomy in patients with glaucoma secondary to uveitis (UG), to compare outcomes with those achieved elsewhere by primary mitomycin C-enhanced trabeculectomy and primary glaucoma drainage implant (GDI) surgery and to consider the optimal surgical approach in this group of patients.

Methods: A retrospective analysis of a single-surgeon series of 31 eyes of 25 patients with UG attending the Manchester Uveitis Clinic who had undergone 5FU-enhanced trabeculectomy between October 2002 and August 2010. Main outcome measures were an intraocular pressure (IOP)<21 mm Hg with medications (unqualified success) and with medications (qualified success). Secondary outcome measures were IOP≤66% of initial IOP. Other risk factors and postoperative complications were also examined.

Results: The mean follow-up was 5.1 years. Qualified success for postoperative IOP control of <21 was achieved in 90.3% at 1 year and 76.5% at 5 years. IOP<66% of initial IOP was achieved in 93.5% at 1 year and 82.3% at 5 years. No patients developed long-term hypotony. Patients under 30 years of age at surgery were at a higher risk for bleb failure and 50% in this age group went on to require GDI surgery.

Conclusions: This study demonstrates good long-term survival rates of 5FU-enhanced trabeculectomy in patients with UG, comparable with results for primary open-angle glaucoma. The results also compare favorably with those of mitomycin C-enhanced trabeculectomy and GDIs in patients with UG, with a lower risk of complications. We conclude that for patients over 30 years, 5FU-enhanced trabeculectomy is appropriate first-line surgery, whereas GDI surgery should be used as the primary procedure for those under 30 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0b013e318255dc07DOI Listing
May 2014

Vision-related quality of life and employment status in patients with uveitis of working age: a prospective study.

Ocul Immunol Inflamm 2012 Aug 9;20(4):262-5. Epub 2012 May 9.

Manchestesr Royal Eye Hospital, Manchestesr, UK.

Purpose: To explore the quality of life and employment status of patients with chronic uveitis using oral immunosuppression.

Methods: A prospective questionnaire-based study.

Results: Forty-six patients had a mean Vision Core Module 1 (VCM1) score of 1.4. The 41 patients with binocular acuity better than or equal to +0.3 logMAR (able to drive) achieved a mean score of 1.2. The 5 patients worse than +0.3 logMAR scored 2.6. This difference was highly significant. Six were unemployed (4 having lost their job because of uveitis-related problems); 3 felt at risk of losing their job; 13 believed their employers had concerns about their sick leave, and 7 used annual leave for hospital visits.

Conclusion: Chronic uveitis, even if well controlled, can have substantial effects on a patient's social and psychological health, and can lead to significant work disability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273948.2012.684420DOI Listing
August 2012

Treatment of acute anterior uveitis in the community, as seen in an emergency eye centre. A lesson for the general practitioner?

Eur J Gen Pract 2012 Mar 22;18(1):26-9. Epub 2011 Sep 22.

Background: Acute anterior uveitis (AAU) is a potentially serious ocular condition, which frequently presents to the General Practitioner (GP). In some cases, it can be misdiagnosed with consequent delay in the initiation of appropriate treatment.

Objectives: To analyse the diagnostic features of AAU presenting to the emergency service at Manchester Royal Eye Hospital; to investigate the prior management of AAU in the community and identify management problems amenable to constructive feedback.

Methods: A list of reasonable standards expected from primary carers was compiled and information collected prospectively by nurse practitioners over two months using a specifically designed pro-forma. Data was analysed against these standards and compared to the relevant literature.

Results: Of the AAU patients 18/69 had previously seen the GP. 14 had first episodes, 4 were recurrent. Mean interval between symptom onset and eye emergency attendance was 9.2 days compared to 4.3 days for those not seen by GP. Symptoms elicited, in those previously seen by a GP, were: ocular pain (18/18); photophobia (17/18); unilateral red eye (17/18); and blurred vision (15/18). GP performed ocular examination in 12 patients. Seven patients were not treated by GP but referred on the same day. The other 11 patients were prescribed topical antibiotics by GP and 2/11 also received topical steroid. 9 of these 11 patients eventually self-checked into eye emergency, whereas two were subsequently referred after re-visiting the GP.

Conclusion: A significant number of AAU patients present to the GP and may be misdiagnosed with an alternative condition such as conjunctivitis. Awareness of AAU presentation and the need for prompt referral, to avoid potential visual loss, needs to be improved by providing feedback to GPs following patient attendance to eye emergency services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/13814788.2011.618221DOI Listing
March 2012

Very severe HLA B27-associated panuveitis mimicking endophthalmitis: a case series.

Ocul Immunol Inflamm 2010 Apr;18(2):139-41

Manchester Royal Eye Hospital, Manchester, UK.

Purpose: To report rare but important instances of very severe, hyperacute HLA B27-associated panuveitis, mimicking infective endophthalmitis and providing challenges to both diagnosis and management.

Design: Retrospective case review.

Methods: Four patient records were reviewed. Demographic features, clinical findings, course of uveitis, diagnostic/therapeutic measures, and outcomes are reported.

Results: All cases presented with severe panuveitis with visual acuities below 6/60 and poor fundal views. Three patients underwent intraocular fluid sampling for microbiology. All required systemic high-dose corticosteroid treatment, and two also needed oral immunosuppression. All eventually required cataract extraction. Final visual acuity varied from 6/12 to 6/6.

Conclusions: HLA B27-associated uveitis may be unusually severe and may cause a panuveitis, mimicking infective endophthalmitis. The course may be prolonged and difficult with frequent complications including cataract.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273940903560236DOI Listing
April 2010

Chronic intraocular copper foreign body and candida: a unique combination.

Ocul Immunol Inflamm 2009 Sep-Oct;17(5):356-60

Manchester Academic Health Sciences Centre, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.

Purpose: To describe a case of unilateral intermediate uveitis, retained copper intraocular foreign body (IOFB) and fungus.

Methods: Interventional case report.

Results: Brown-orange discoloration of the iris, lens and opacified vitreous was observed. Computed tomography revealed a retained IOFB, which was composed of copper. IOFB was removed during vitrectomy and cataract surgery. Copper deposition was demonstrated on the anterior capsule. Incidentally, dimorphic fungus were found in the vitreous.

Conclusions: The presence of intraocular copper might have reduced the virulence of the fungus preventing endophthalmitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09273940903075370DOI Listing
January 2010

Sarcoidosis.

Authors:
Nicholas P Jones

Curr Opin Ophthalmol 2002 Dec;13(6):393-6

Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, UK.

Sarcoidosis commonly involves the eye, causing uveitis, the lacrimal gland, and the cranial nerves, including the optic nerve itself. Several microorganism types have recently been located in sarcoid granulomas, suggesting an infective cause in predisposed individuals. The approach to diagnosis has been refined, including the use of high-resolution computed tomography of the chest. New ophthalmic manifestations have been described, suggesting a wider role for sarcoidosis in intraocular inflammation, and indocyanine green angiography has clarified choroidal involvement. Immunosuppressive and anticytokine treatments can be effective in severe systemic sarcoidosis and should be considered in sight-threatening disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/00055735-200212000-00009DOI Listing
December 2002
-->