The advent of the discipline of molecular genetics over the past decade has led to a dramatic gro... more The advent of the discipline of molecular genetics over the past decade has led to a dramatic growth in our understanding of the genetics of a myriad of diseases. Ophthalmology has benefited greatly from this new technology, with significant advances in our knowledge about conditions as varied as aniridia and retinitis pigmentosa.1 2 Our understanding of the genetics of primary open angle glaucoma (POAG) may not be as clear as with some other ophthalmic conditions but, nevertheless, there have been great advances since the last review about the genetics of glaucoma published in the BJO in 1980.3 At that time, our knowledge was based on a number of conflicting studies attempting to link human polymorphisms, such as the ability to taste phenyl thiocar-bamide, with glaucoma.4 Nowadays, the positions of genes
The recent review by Harper et al. on glaucoma care pathways looked at the virtual glaucoma clini... more The recent review by Harper et al. on glaucoma care pathways looked at the virtual glaucoma clinic (VGC) and stated that “Clinical leads largely rate...the perception of patients’ acceptability to be at least equivalent to standard care” [1]. We have recently looked at the question of patient perceptions of our local VGC and how it compares with standard care i.e. traditional doctor-delivered clinics. A Patient Satisfaction Questionnaire was sent out to 118 patients who had attended at least both one VGC and one traditional glaucoma clinic at The Royal Eye Infirmary, Plymouth. Sixty-eight responses were received and analysed in March 2020 (Table 1). Overall, 95% felt that the waiting times were the same or better than a traditional clinic. Overall, 97% of patients were satisfied or very satisfied with the thoroughness of the VGC. A total of 85% were satisfied or very satisfied with the information provided to them in the follow up letter from the clinician with 94% of patients feeling that the information was the same or better when compared with a traditional clinic. Overall, 98% of patients felt that the VGC was the same as or better than a traditional clinic (Fig. 1). Most comments were positive, highlighting the quick and efficient service. The negative comments arose from not receiving a feedback letter from the clinician, distant travel to the clinic and only one patient was disappointed at not being able to ask a doctor questions. Our study therefore presents good evidence that patients feel that the VGC is at least as good as the traditional clinic and in many aspects better than the doctor-led clinic.
To report an unusual case of bilateral choroidal folds related to multiple myeloma. In this case ... more To report an unusual case of bilateral choroidal folds related to multiple myeloma. In this case report, fundus photography, fundus fluorescein angiography, fundus autofluorescence, and B-ultrasonography were used to assess posterior segment changes. A 55-year-old woman with history of multiple myeloma was found to have abnormal fundi. Clinical examination and investigations confirmed chorioretinal folds, which was considered to be related to myeloma. Close monitoring ensued for 2 years with no significant changes. Subsequently, she was treated with stem cell transplant for myeloma, which resulted in remission of her disease. She was also noted to have marked improvement of chorioretinal folds within 1 year. Visual function remained normal throughout the follow-up period. Multiple myeloma can infiltrate choroidal tissue, resulting in chorioretinal folds. Stem cell transplant was associated with significant reduction in paraprotein levels and choroidal folds.
Hereditary retinal degenerations encompass a group of genetic diseases characterized by extreme c... more Hereditary retinal degenerations encompass a group of genetic diseases characterized by extreme clinical variability. Following next-generation sequencing and autozygome-based screening of patients presenting with a peculiar, recessive form of cone-dominated retinopathy, we identified five homozygous variants [p.(Asp594fs), p.(Gln117*), p.(Met712fs), p.(Ile756Phe), and p.(Glu543Lys)] in the polyglutamylase-encoding gene TTLL5, in eight patients from six families. The two male patients carrying truncating TTLL5 variants also suffered from a substantial reduction in sperm motility and infertility, whereas those carrying missense changes were fertile. Defects in this polyglutamylase in humans have recently been associated with cone photoreceptor dystrophy, while mouse models carrying truncating mutations in the same gene also display reduced fertility in male animals. We examined the expression levels of TTLL5 in various human tissues and determined that this gene has multiple viable i...
Tumminia and colleagues 1 recently suggested that human trabecular meshwork cells, used to model ... more Tumminia and colleagues 1 recently suggested that human trabecular meshwork cells, used to model juxtacanalicular cells, respond to mechanical stretch by an alteration in their cytoskeletal network and signaling cascades. They further postulated that, in the long-term ...
Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Se... more Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Self limiting follicular conjunctivitis is probably the most common early ocular manifestation and occurs within the …
To investigate the genetic basis of recessively-inherited congenital, non syndromic, bilateral, t... more To investigate the genetic basis of recessively-inherited congenital, non syndromic, bilateral, total sclerocornea in two consanguineous pedigrees, one from the Punjab province of Pakistan and the other from the Tlaxcala province of Mexico. Ophthalmic examinations were conducted on each family member to confirm their diagnosis and magnetic resonance imaging (MRI) or ultrasonography of the eyes was performed on some family members. Genomic DNA was analyzed by homozygosity mapping using the Affymetrix 6.0 SNP array and linkage was confirmed with polymorphic microsatellite markers. Candidate genes were sequenced. A diagnosis of autosomal recessive sclerocornea was established for 7 members of the Pakistani and 8 members of the Mexican pedigrees. In the Pakistani family we established linkage to a region on chromosome 1p that contained Forkhead Box E3 (FOXE3), a strong candidate gene since FOXE3 mutations had previously been associated with various anterior segment abnormalities. Sequen...
This study compared the position of the foveal center in patients with X-linked retinoschisis (XL... more This study compared the position of the foveal center in patients with X-linked retinoschisis (XLRS) and controls and estimated the frequency of foveal ectopia in XLRS. Fundus photographs of 23 patients with XLRS and 25 controls were reviewed. The position of the foveal center relative to the vertical center of the optic disk was determined from magnified images and expressed as the angle between the disk and foveal centers, relative to the horizontal meridian. The shortest distance between the foveal and disk centers was also measured, using the horizontal disk diameter (HDD) as the relative size unit. The position of the foveal center could be determined accurately for 43 eyes of the 23 patients with XLRS. The foveal center was located an average of 4.7 degrees (standard deviation, 9.3) below and 3.2 HDD (standard deviation, 0.4) temporal to the vertical disk center. In 9 (21 %) of the eyes, the fovea was above the horizontal meridian. For the control eyes, the foveal center was an average of 7.8 degrees (standard deviation, 2.3) below and 2.9 HDD (standard deviation, 0.4) temporal to the vertical disk center. According to a previous definition, foveal ectopia was present in 13 (30%) of the eyes with XLRS and none of the control eyes (P < 0.001). Foveal ectopia occurs in at least 30% of eyes with XLRS. This finding may provide a useful diagnostic sign for XLRS and may have implications for its pathogenesis.
1. Lancet. 2000 Mar 4;355(9206):846-7. Swedish in-vitro fertilisation study. D'Souza... more 1. Lancet. 2000 Mar 4;355(9206):846-7. Swedish in-vitro fertilisation study. D'Souza SW, Richards B, Lieberman BA. Comment on: Lancet. 1999 Nov 6;354(9190):1579-85. PMID: 10711954 [PubMed - indexed for MEDLINE]. ...
These data demonstrate that urologists who practice in Madrid have a good theoretical knowledge o... more These data demonstrate that urologists who practice in Madrid have a good theoretical knowledge of IFIS. As we expected, tamsulosin is by far the preferred drug for treating BPH. The degree of knowledge was similar in all participating hospitals, and we did not find a correlation with any of the studied variables. Not surprisingly, most urologists were ignorant of the morphologic changes induced by the drug and thought that IFIS could be reversed easily by stopping tamsulosin days before surgery. Morepublications about this topic inurology journals may increase the level of knowledgeof certain aspects of IFIS amongmembers of the urology community. Better knowledge of this syndromeby the urology community should, in the intermediate term, result in a reduction in the prevalence and severity of the syndrome and an increase in the safety of cataract surgery.
PURPOSE. To identify the defective gene in the sex-linked, recessively inherited retinal dysplasi... more PURPOSE. To identify the defective gene in the sex-linked, recessively inherited retinal dysplasia and degeneration (rdd) chicken and to search for the human equivalent disease. METHODS. Microsatellites from chicken chromosome Z were genotyped in 77 progeny of a carrier male (rdd/ϩ) and an affected female (rdd/W), and candidate genes were sequenced. Retinal cross-sections from rdd and wild-type birds were analyzed by immunohistology. The human orthologous gene was screened in a panel of archival DNAs from 276 patients with retinitis pigmentosa (RP) or Leber congenital amaurosis (LCA) using melting curve analysis and DNA sequencing. RESULTS. The rdd locus was refined to an approximately 3-Mb region on chromosome Z. Sequence analysis identified a C3 T change in the mpdz gene that created a premature stop codon (c.1372C3 T, p.R458X), which segregated with the disease phenotype. As expected, the full-length mpdz protein was absent in rdd retinas, but in wild-type birds, it localized to the retinal outer limiting membrane, where it may have a role in the interactions between photoreceptors and Müller glia cells. The screen to identify the human equivalent disease found 10 heterozygous variants in the orthologous gene in patients with RP (three missense and two null alleles) and LCA (four missense and one null allele). CONCLUSIONS. These findings reveal that MPDZ is essential for normal development of the retina and may have a role in maintaining photoreceptor integrity. The identification of human mutations suggests that MPDZ plays a role in human retinal disease, but the precise nature of this role remains to be determined.
Mutations in the PAX 6 gene are known to cause many cases of inherited and sporadic aniridia. Alt... more Mutations in the PAX 6 gene are known to cause many cases of inherited and sporadic aniridia. Although embryologically similar to an iridia, the cause of Peters' anomaly has received far less attention. Two reports have been published demonstrating mutations in the PAX 6 gene in Peters' anomaly. We have analysed the PAX 6 gene in 15 individuals with Peters' anomaly (7 familial, 8 sporadic). This is the largest cohort of Peters' anomaly described. The PAX 6 gene was screened using a combination of single-strand conformational polymorphism gel electrophoresis and direct sequencing. No mutations were found in the coding region of the PAX 6 gene. We feel that Peters' anomaly is a heterogeneous condition and that for the majority of cases PAX 6 is not the 'Peters' anomaly gene'.
Introduction. Following laboratory studies on new potential chemotherapy for Acanthamoeba keratit... more Introduction. Following laboratory studies on new potential chemotherapy for Acanthamoeba keratitis, when chlorhexidine and propamidine provided an additive in vitro effect, a series of 12 patients with culture-proven Acanthamoeba keratitis from three UK centres was monitored during and after therapy. Methods. In all cases the clinical diagnosis was confirmed by amoebal culture. In some instances identification of the protozoa by direct microscopy of corneal tissue was possible. The medication was provided topically in drop form until the keratitis had resolved. In vitro sensitivity to chlorhexidine and propamidine was performed on all isolates and com pared with sensitivity to a range of other drugs used for treatment of the infection. Results. In vitro drug testing confirmed that tropho zoites and cysts of all 12 Acanthamoeba isolates were fully sensitive to chlorhexidine and propamidine. Therapy was satisfactory for controlling and eradicating the acanthamoebal infection in all patients. Three patients developed discrete stromal infiltration at the site of infection that resolved 1 week after commencing therapy, with or without use of steroids. Two patients developed a late inflammatory effect in the stromal scar at 6 months, which resolved with steroids. No clinical evidence of chlorhexidine toxicity was found in any patient. Conclusions. The combination of topical chlorhexidine and propamidine was very effective for treating Acanthamoeba keratitis provided the drugs were continued for a sufficient period. No drug toxicity or
The recent publication of the NICE glaucoma guidelines (http://www.nice.org.uk/) has led to a lar... more The recent publication of the NICE glaucoma guidelines (http://www.nice.org.uk/) has led to a large increase in new patient referrals from community optometrists to the Hospital Eye Service (HES) with possible glaucoma. Changes in population demographics mean that these numbers are likely to rise further in the coming years. As well as putting a strain on the HES capacity, this increase in potentially false-positive referrals has significant financial implications for PCTs and can cause unnecessary distress and anxiety to patients. The majority of …
Background-Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical inter... more Background-Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical intervention is always associated with a high risk of failure or reactivation of the inflammatory disease. In this study we prospectively examined the value of transscleral diode laser cyclophotocoagulation (TDLC) for the treatment of refractory inflammatory glaucoma. Methods-22 eyes of 20 consecutive patients with inflammatory, medically uncontrollable, glaucoma secondary to chronic uveitis/trabeculitis (n = 18), chemical injury (n = 2), episcleritis (n = 1), and necrotising scleritis with inflammation (n = 1) were treated by TDLC. Nine eyes (41%) had had previous failed glaucoma surgery (trabeculectomy, cyclocryocoagulation) and 15 eyes (68.2%) had had previous anterior segment surgery. All patients were followed for 1 year after the initial treatment. Results-Within 12 months of the first treatment the intraocular pressure was controlled in 77.3% of all eyes (72.2% of those with uveitic glaucoma). No serious side eVects such as activation of the inflammatory process, phthisis bulbi or persistent hypotonia were observed, except one patient with a temporary fibrin reaction. More than one treatment was necessary in 63.6% of the patients. The use of systemic carbonic anhydrase inhibitors was reduced from 68.2% before treatment to 27.3% after 1 year. Conclusion-TDLC seems to be a safe and eVective procedure for the treatment of inflammatory glaucoma and may become an alternative to trabeculectomy with antimetabolites in uveitic glaucoma. TDLC may become the surgical procedure of choice in treating secondary glaucoma caused by chemical injury and also in scleritis associated glaucoma, using reduced parameters for application.
The advent of the discipline of molecular genetics over the past decade has led to a dramatic gro... more The advent of the discipline of molecular genetics over the past decade has led to a dramatic growth in our understanding of the genetics of a myriad of diseases. Ophthalmology has benefited greatly from this new technology, with significant advances in our knowledge about conditions as varied as aniridia and retinitis pigmentosa.1 2 Our understanding of the genetics of primary open angle glaucoma (POAG) may not be as clear as with some other ophthalmic conditions but, nevertheless, there have been great advances since the last review about the genetics of glaucoma published in the BJO in 1980.3 At that time, our knowledge was based on a number of conflicting studies attempting to link human polymorphisms, such as the ability to taste phenyl thiocar-bamide, with glaucoma.4 Nowadays, the positions of genes
The recent review by Harper et al. on glaucoma care pathways looked at the virtual glaucoma clini... more The recent review by Harper et al. on glaucoma care pathways looked at the virtual glaucoma clinic (VGC) and stated that “Clinical leads largely rate...the perception of patients’ acceptability to be at least equivalent to standard care” [1]. We have recently looked at the question of patient perceptions of our local VGC and how it compares with standard care i.e. traditional doctor-delivered clinics. A Patient Satisfaction Questionnaire was sent out to 118 patients who had attended at least both one VGC and one traditional glaucoma clinic at The Royal Eye Infirmary, Plymouth. Sixty-eight responses were received and analysed in March 2020 (Table 1). Overall, 95% felt that the waiting times were the same or better than a traditional clinic. Overall, 97% of patients were satisfied or very satisfied with the thoroughness of the VGC. A total of 85% were satisfied or very satisfied with the information provided to them in the follow up letter from the clinician with 94% of patients feeling that the information was the same or better when compared with a traditional clinic. Overall, 98% of patients felt that the VGC was the same as or better than a traditional clinic (Fig. 1). Most comments were positive, highlighting the quick and efficient service. The negative comments arose from not receiving a feedback letter from the clinician, distant travel to the clinic and only one patient was disappointed at not being able to ask a doctor questions. Our study therefore presents good evidence that patients feel that the VGC is at least as good as the traditional clinic and in many aspects better than the doctor-led clinic.
To report an unusual case of bilateral choroidal folds related to multiple myeloma. In this case ... more To report an unusual case of bilateral choroidal folds related to multiple myeloma. In this case report, fundus photography, fundus fluorescein angiography, fundus autofluorescence, and B-ultrasonography were used to assess posterior segment changes. A 55-year-old woman with history of multiple myeloma was found to have abnormal fundi. Clinical examination and investigations confirmed chorioretinal folds, which was considered to be related to myeloma. Close monitoring ensued for 2 years with no significant changes. Subsequently, she was treated with stem cell transplant for myeloma, which resulted in remission of her disease. She was also noted to have marked improvement of chorioretinal folds within 1 year. Visual function remained normal throughout the follow-up period. Multiple myeloma can infiltrate choroidal tissue, resulting in chorioretinal folds. Stem cell transplant was associated with significant reduction in paraprotein levels and choroidal folds.
Hereditary retinal degenerations encompass a group of genetic diseases characterized by extreme c... more Hereditary retinal degenerations encompass a group of genetic diseases characterized by extreme clinical variability. Following next-generation sequencing and autozygome-based screening of patients presenting with a peculiar, recessive form of cone-dominated retinopathy, we identified five homozygous variants [p.(Asp594fs), p.(Gln117*), p.(Met712fs), p.(Ile756Phe), and p.(Glu543Lys)] in the polyglutamylase-encoding gene TTLL5, in eight patients from six families. The two male patients carrying truncating TTLL5 variants also suffered from a substantial reduction in sperm motility and infertility, whereas those carrying missense changes were fertile. Defects in this polyglutamylase in humans have recently been associated with cone photoreceptor dystrophy, while mouse models carrying truncating mutations in the same gene also display reduced fertility in male animals. We examined the expression levels of TTLL5 in various human tissues and determined that this gene has multiple viable i...
Tumminia and colleagues 1 recently suggested that human trabecular meshwork cells, used to model ... more Tumminia and colleagues 1 recently suggested that human trabecular meshwork cells, used to model juxtacanalicular cells, respond to mechanical stretch by an alteration in their cytoskeletal network and signaling cascades. They further postulated that, in the long-term ...
Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Se... more Lyme disease has several important ophthalmic manifestations that are important to highlight.1 Self limiting follicular conjunctivitis is probably the most common early ocular manifestation and occurs within the …
To investigate the genetic basis of recessively-inherited congenital, non syndromic, bilateral, t... more To investigate the genetic basis of recessively-inherited congenital, non syndromic, bilateral, total sclerocornea in two consanguineous pedigrees, one from the Punjab province of Pakistan and the other from the Tlaxcala province of Mexico. Ophthalmic examinations were conducted on each family member to confirm their diagnosis and magnetic resonance imaging (MRI) or ultrasonography of the eyes was performed on some family members. Genomic DNA was analyzed by homozygosity mapping using the Affymetrix 6.0 SNP array and linkage was confirmed with polymorphic microsatellite markers. Candidate genes were sequenced. A diagnosis of autosomal recessive sclerocornea was established for 7 members of the Pakistani and 8 members of the Mexican pedigrees. In the Pakistani family we established linkage to a region on chromosome 1p that contained Forkhead Box E3 (FOXE3), a strong candidate gene since FOXE3 mutations had previously been associated with various anterior segment abnormalities. Sequen...
This study compared the position of the foveal center in patients with X-linked retinoschisis (XL... more This study compared the position of the foveal center in patients with X-linked retinoschisis (XLRS) and controls and estimated the frequency of foveal ectopia in XLRS. Fundus photographs of 23 patients with XLRS and 25 controls were reviewed. The position of the foveal center relative to the vertical center of the optic disk was determined from magnified images and expressed as the angle between the disk and foveal centers, relative to the horizontal meridian. The shortest distance between the foveal and disk centers was also measured, using the horizontal disk diameter (HDD) as the relative size unit. The position of the foveal center could be determined accurately for 43 eyes of the 23 patients with XLRS. The foveal center was located an average of 4.7 degrees (standard deviation, 9.3) below and 3.2 HDD (standard deviation, 0.4) temporal to the vertical disk center. In 9 (21 %) of the eyes, the fovea was above the horizontal meridian. For the control eyes, the foveal center was an average of 7.8 degrees (standard deviation, 2.3) below and 2.9 HDD (standard deviation, 0.4) temporal to the vertical disk center. According to a previous definition, foveal ectopia was present in 13 (30%) of the eyes with XLRS and none of the control eyes (P < 0.001). Foveal ectopia occurs in at least 30% of eyes with XLRS. This finding may provide a useful diagnostic sign for XLRS and may have implications for its pathogenesis.
1. Lancet. 2000 Mar 4;355(9206):846-7. Swedish in-vitro fertilisation study. D'Souza... more 1. Lancet. 2000 Mar 4;355(9206):846-7. Swedish in-vitro fertilisation study. D'Souza SW, Richards B, Lieberman BA. Comment on: Lancet. 1999 Nov 6;354(9190):1579-85. PMID: 10711954 [PubMed - indexed for MEDLINE]. ...
These data demonstrate that urologists who practice in Madrid have a good theoretical knowledge o... more These data demonstrate that urologists who practice in Madrid have a good theoretical knowledge of IFIS. As we expected, tamsulosin is by far the preferred drug for treating BPH. The degree of knowledge was similar in all participating hospitals, and we did not find a correlation with any of the studied variables. Not surprisingly, most urologists were ignorant of the morphologic changes induced by the drug and thought that IFIS could be reversed easily by stopping tamsulosin days before surgery. Morepublications about this topic inurology journals may increase the level of knowledgeof certain aspects of IFIS amongmembers of the urology community. Better knowledge of this syndromeby the urology community should, in the intermediate term, result in a reduction in the prevalence and severity of the syndrome and an increase in the safety of cataract surgery.
PURPOSE. To identify the defective gene in the sex-linked, recessively inherited retinal dysplasi... more PURPOSE. To identify the defective gene in the sex-linked, recessively inherited retinal dysplasia and degeneration (rdd) chicken and to search for the human equivalent disease. METHODS. Microsatellites from chicken chromosome Z were genotyped in 77 progeny of a carrier male (rdd/ϩ) and an affected female (rdd/W), and candidate genes were sequenced. Retinal cross-sections from rdd and wild-type birds were analyzed by immunohistology. The human orthologous gene was screened in a panel of archival DNAs from 276 patients with retinitis pigmentosa (RP) or Leber congenital amaurosis (LCA) using melting curve analysis and DNA sequencing. RESULTS. The rdd locus was refined to an approximately 3-Mb region on chromosome Z. Sequence analysis identified a C3 T change in the mpdz gene that created a premature stop codon (c.1372C3 T, p.R458X), which segregated with the disease phenotype. As expected, the full-length mpdz protein was absent in rdd retinas, but in wild-type birds, it localized to the retinal outer limiting membrane, where it may have a role in the interactions between photoreceptors and Müller glia cells. The screen to identify the human equivalent disease found 10 heterozygous variants in the orthologous gene in patients with RP (three missense and two null alleles) and LCA (four missense and one null allele). CONCLUSIONS. These findings reveal that MPDZ is essential for normal development of the retina and may have a role in maintaining photoreceptor integrity. The identification of human mutations suggests that MPDZ plays a role in human retinal disease, but the precise nature of this role remains to be determined.
Mutations in the PAX 6 gene are known to cause many cases of inherited and sporadic aniridia. Alt... more Mutations in the PAX 6 gene are known to cause many cases of inherited and sporadic aniridia. Although embryologically similar to an iridia, the cause of Peters' anomaly has received far less attention. Two reports have been published demonstrating mutations in the PAX 6 gene in Peters' anomaly. We have analysed the PAX 6 gene in 15 individuals with Peters' anomaly (7 familial, 8 sporadic). This is the largest cohort of Peters' anomaly described. The PAX 6 gene was screened using a combination of single-strand conformational polymorphism gel electrophoresis and direct sequencing. No mutations were found in the coding region of the PAX 6 gene. We feel that Peters' anomaly is a heterogeneous condition and that for the majority of cases PAX 6 is not the 'Peters' anomaly gene'.
Introduction. Following laboratory studies on new potential chemotherapy for Acanthamoeba keratit... more Introduction. Following laboratory studies on new potential chemotherapy for Acanthamoeba keratitis, when chlorhexidine and propamidine provided an additive in vitro effect, a series of 12 patients with culture-proven Acanthamoeba keratitis from three UK centres was monitored during and after therapy. Methods. In all cases the clinical diagnosis was confirmed by amoebal culture. In some instances identification of the protozoa by direct microscopy of corneal tissue was possible. The medication was provided topically in drop form until the keratitis had resolved. In vitro sensitivity to chlorhexidine and propamidine was performed on all isolates and com pared with sensitivity to a range of other drugs used for treatment of the infection. Results. In vitro drug testing confirmed that tropho zoites and cysts of all 12 Acanthamoeba isolates were fully sensitive to chlorhexidine and propamidine. Therapy was satisfactory for controlling and eradicating the acanthamoebal infection in all patients. Three patients developed discrete stromal infiltration at the site of infection that resolved 1 week after commencing therapy, with or without use of steroids. Two patients developed a late inflammatory effect in the stromal scar at 6 months, which resolved with steroids. No clinical evidence of chlorhexidine toxicity was found in any patient. Conclusions. The combination of topical chlorhexidine and propamidine was very effective for treating Acanthamoeba keratitis provided the drugs were continued for a sufficient period. No drug toxicity or
The recent publication of the NICE glaucoma guidelines (http://www.nice.org.uk/) has led to a lar... more The recent publication of the NICE glaucoma guidelines (http://www.nice.org.uk/) has led to a large increase in new patient referrals from community optometrists to the Hospital Eye Service (HES) with possible glaucoma. Changes in population demographics mean that these numbers are likely to rise further in the coming years. As well as putting a strain on the HES capacity, this increase in potentially false-positive referrals has significant financial implications for PCTs and can cause unnecessary distress and anxiety to patients. The majority of …
Background-Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical inter... more Background-Inflammatory glaucoma is still a diagnostic and therapeutic dilemma and surgical intervention is always associated with a high risk of failure or reactivation of the inflammatory disease. In this study we prospectively examined the value of transscleral diode laser cyclophotocoagulation (TDLC) for the treatment of refractory inflammatory glaucoma. Methods-22 eyes of 20 consecutive patients with inflammatory, medically uncontrollable, glaucoma secondary to chronic uveitis/trabeculitis (n = 18), chemical injury (n = 2), episcleritis (n = 1), and necrotising scleritis with inflammation (n = 1) were treated by TDLC. Nine eyes (41%) had had previous failed glaucoma surgery (trabeculectomy, cyclocryocoagulation) and 15 eyes (68.2%) had had previous anterior segment surgery. All patients were followed for 1 year after the initial treatment. Results-Within 12 months of the first treatment the intraocular pressure was controlled in 77.3% of all eyes (72.2% of those with uveitic glaucoma). No serious side eVects such as activation of the inflammatory process, phthisis bulbi or persistent hypotonia were observed, except one patient with a temporary fibrin reaction. More than one treatment was necessary in 63.6% of the patients. The use of systemic carbonic anhydrase inhibitors was reduced from 68.2% before treatment to 27.3% after 1 year. Conclusion-TDLC seems to be a safe and eVective procedure for the treatment of inflammatory glaucoma and may become an alternative to trabeculectomy with antimetabolites in uveitic glaucoma. TDLC may become the surgical procedure of choice in treating secondary glaucoma caused by chemical injury and also in scleritis associated glaucoma, using reduced parameters for application.
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Papers by Adam Booth