Opthalmology & Visual Sciences publications

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Open Access
119 loci influencing intraocular pressure provide new insight into primary open angle glaucoma susceptibility and age of onset
(Association for Research in Vision and Ophthalmology, 2018) Craig, J.E.; Hewitt, A.W.; Mackey, D.; Graham, S.L.; Healey, P.R.; White, A.J.R.; Landers, J.; Casson, R.; Souzeau, E.; Burdon, K.P.; Gharahkhani, P.; MacGregor, S.; Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO 2018) (29 Apr 2018 - 3 May 2018 : Honolulu, HI)
Open Access
A glaucoma polygenic risk score strongly associated with disease prediction and treatment intensity
(Association for Research in Vision and Ophthalomology, 2019) Craig, J.E.; Qassim, A.; Han, X.; Hassall, M.; Casson, R.J.; Graham, S.L.; Mackey, D.A.; Willoughby, C.; Burdon, K.P.; Landers, J.; Souzeau, E.; Wiggs, J.L.; Hewitt, A.W.; MacGregor, S.; Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) (28 Apr 2019 - 2 May 2019 : Vancouver, Canada)
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A multi-centre case series investigating the aetiology of hypertrophic pachymeningitis with orbital inflammation
(Taylor & Francis The Netherlands, 2011) Cannon, P.; Cruz, A.; Carolina, P.; Mastropietro, D.; Chahud, F.; Bilyk, J.; Selva-Nayagam, D.; Prabhakaran, V.
INTRODUCTION: To describe our attempt in establishing a definitive diagnosis in patients with hypertrophic pachymeningitis in combination with orbital inflammatory disease and report on the outcome. MATERIALS AND METHODS: This was a retrospective case series of all patients presenting with hypertrophic pachymeningitis in association with orbital inflammation in 4 centres. Ophthalmic and neurological examination data, laboratory data, histology data, treatment plans and clinical outcome data were recorded. Patients underwent orbital/brain computed tomography and magnetic resonance imaging. RESULTS: Six patients were identified; the median age was 46.5 years. Headache was the commonest presenting symptom, followed by diplopia and reduced visual acuity. Three patients underwent orbital biopsy, 1 patient underwent dura mater biopsy, 1 patient underwent both and 1 patient underwent nasal biopsy. Four patients were diagnosed with Wegener granulomatosis and 2 patients with tuberculosis. Corticosteroid therapy was initiated in 4 patients, with steroid-sparing drugs added later. Two patients received anti-tuberculosis treatment and 1 patient was commenced on pulsed cyclophosphamide. On follow-up, 1 patient required an exenteration for a painful blind eye and 1 patient’s visual acuity remained at no perception to light. One patient had complete resolution of symptoms on treatment, 1 patient had persistent reduced visual acuity and 1 patient was lost to follow-up. CONCLUSION: We postulate that the combination of orbital inflammation and pachymeningitis is strongly suggestive of Wegener granulomatosis, although it may take a number of years to confirm. Tuberculosis should also be considered.
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A one-point technique for per-operative corneal meridian identification: corneal marking technique
(Springer-Verlag, 2013) Durkin, S.; Goggin, M.
Open Access
A polygenic risk score predicts functional progression in early primary open-angle glaucoma
(Association for Research in Vision & Ophthalmology, 2022) Siggs, O.; Qassim, A.; Han, X.; Marshall, H.; Mullany, S.; Souzeau, E.; Galanopoulos, A.; Agar, A.; Landers, J.; Casson, R.; Hewitt, A.W.; Healey, P.; Graham, S.L.; MacGregor, S.; Craig, J.; The Association for Research in Vision & Ophthalmology Annual Meeting (ARVO) (1 May 2022 - 5 May 2022 : Denver, CO, USA & online)
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A polygenic risk score predicts intraocular pressure readings outside office hours and early morning spikes as measured by home tonometry
(Elsevier, 2020) Qassim, A.; Mullany, S.; Awadalla, M.S.; Hassall, M.M.; Nguyen, T.; Marshall, H.; Kolovos, A.; Schulz, A.M.; Han, X.; Gharahkhani, P.; Galanopoulos, A.; Agar, A.; Healey, P.R.; Hewitt, A.W.; Landers, J.; Casson, R.J.; Graham, S.L.; MacGregor, S.; Souzeau, E.; Siggs, O.M.; et al.
OBJECTIVE: Intraocular pressure (IOP) elevations may occur in early morning or outside office hours and can be missed during routine in-clinic IOP measurements. Such fluctuations or peaks likely contribute to glaucoma progression. We sought to investigate the relationship between an IOP polygenic risk score (PRS) and short-term IOP profile. DESIGN: Cross-sectional study. PARTICIPANTS: 473 eyes from 239 participants with suspected or established primary open angle glaucoma sampled from the PROGRESSA study from four outpatient ophthalmology clinics in Australia between August 2016 and December 2019. METHODS: Participants underwent Icare HOME tonometer measurements to record IOP four times a day for five days. Unreliable measurements were excluded. A minimum of two days with at least three reliable measurements were required. We used a previously-validated IOP PRS derived from 146 common IOP-associated variants in a linear regression model with adjustment for central corneal thickness and age. MAIN OUTCOME MEASURES: Highest recorded early-morning IOP, and mean IOP within and outside office hours. Early-morning IOP spikers were defined as eyes with a higher early-morning IOP than the highest recorded IOP during office hours. RESULTS: 334 eyes from 176 participants (mean age 64 years, SD 9) generated reliable measurements for inclusion. Eyes in the highest IOP PRS quintile had an early-morning IOP increase by 4.3 mmHg (95% confidence interval [CI] 1.4-7.3; P = 0.005) and mean IOP outside office hours increase of 2.7 mmHg (95% CI 0.61-4.7; P = 0.013) than the lowest quintile, which were independently significant after accounting for a recent in-clinic IOP measured by Goldmann applanation tonometry. Eyes in the highest PRS quintile were 5.4-fold more likely to be early-morning IOP spikers than the lowest quintile (odds ratio 95% CI 1.3-23.6; P = 0.023) CONCLUSION: A previously validated IOP PRS was associated with higher early-morning IOP, and mean IOP outside office hours. These findings support a role for genetic risk prediction of susceptibility to elevated IOP that may not be apparent in-clinic hours, requiring more detailed clinical phenotyping using home tonometry, the results of which may guide additional interventions to improve IOP control.
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A prospective outcome study of membranous and solid distal common canalicular obstructions
(Nature Publishing Group, 2016) Shams, P.; Pirbhai, A.; Selva, D.
To prospectively evaluate the surgical outcomes of membranous and solid distal common canalicular obstructions (CCOs) following endoscopic dacryocystorhinostomy (EnDCR) and lacrimal intubation combined with either membranotomy or trephination.This was a prospective, non-randomized, consecutive interventional case series. Inclusion criteria included patients undergoing EnDCR with evidence of a membranous block or more solid obstruction of the distal common canaliculus, treated with membranotomy or canalicular trephination. Complete CCO was confirmed pre-operatively using dacryocystography and dacryoscintigraphy. All patients received bicanalicular intubation for 3 months with a minimum follow-up of 12 months. Functional and anatomical success was assessed at 4 weeks, 3 months, and 12 months following surgery. Functional success was defined as subjective improvement of epiphora and anatomical success as the presence of a patent ostium and a positive dye test on nasal endoscopy.Twenty-nine patients were included in the study with a mean age of 58 years. Twenty-one patients (72%) received a membranotomy and eight (28%) required trephination. At 12 months, the functional and anatomical success rate in the membranotomy group was 90% (19/21) and 100% (21/21), respectively, and in trephination group the functional and anatomical success rate was 63% (5/8). There were no intra-operative or lacrimal stent-related complications.Identifying and excising distal CCOs in association with EnDCR and lacrimal intubation is associated with a high degree of functional (83%) and anatomical (90%) success. The success of membranous obstructions appear be superior to outcomes for solid obstructions of the distal common canaliculus that require trephination.
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A review of bypass tubes for proximal lacrimal drainage obstruction
(Elsevier Science Inc, 2011) Athanasiov, P.; Madge, S.; Kakizaki, H.; Selva-Nayagam, D.
Proximal obstruction of the lacrimal drainage system is typically managed with conjunctivodacryocystorhinostomy and lacrimal bypass tubes, a technique first described in 1962 by Lester Jones. This initial approach utilizes a temporary stent to allow epithelialization of the fistula. Over the last 49 years numerous alterations to this technique have been described, including permanent intubation of the lacrimal bypass fistula, now the most common approach. We review the range of available lacrimal bypass tubes, indications for their use, and surgical techniques for their insertion and focus on improving success rates and minimising short and long-term complications.
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A review of central retinal artery occlusion: clinical presentation and management
(Nature Publishing Group, 2013) Varma, D.; Cugati, S.; Lee, A.; Chen, C.
Central retinal artery occlusion (CRAO) is an ophthalmic emergency and the ocular analogue of cerebral stroke. Best evidence reflects that over three-quarters of patients suffer profound acute visual loss with a visual acuity of 20/400 or worse. This results in a reduced functional capacity and quality of life. There is also an increased risk of subsequent cerebral stroke and ischaemic heart disease. There are no current guideline-endorsed therapies, although the use of tissue plasminogen activator (tPA) has been investigated in two randomized controlled trials. This review will describe the pathophysiology, epidemiology, and clinical features of CRAO, and discuss current and future treatments, including the use of tPA in further clinical trials.
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A review of the mechanisms of cone degeneration in retinitis pigmentosa
(Wiley-Blackwell, 2016) Narayan, D.; Wood, J.; Chidlow, G.; Casson, R.
Retinitis pigmentosa (RP) is an inherited condition that features degeneration of rod and cone photoreceptors. In all forms of RP, the genetic mutation is expressed exclusively in rods; however, cones die too. The secondary death of cones in RP remains somewhat mysterious. A better understanding of the mechanisms that cause cone degeneration in RP could lead to novel treatments that preserve cones. There are a number of prevailing theories that attempt to explain cone degeneration in RP. One concept is that cone survival is dependent on trophic factors produced by rods. Another hypothesis is that cones suffer from a nutrient shortage after rods have been lost. Additionally, oxidative stress and pro-inflammatory microglial activation have also been suggested to play a role in cone death. The present review evaluates the evidence supporting these theories and provides an update on the mechanisms of cone degeneration in RP.
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A Survey of Severe Visual Impairment and Blindness in Children Attending Thirteen Schools for the Blind in Sri Lanka
(Informa Healthcare, 2011) Gao, Z.; Muecke, J.; Edussuriya, K.; Dayawansa, R.; Hammerton, M.; Kong, A.; Sennanayake, S.; Senaratne, T.; Marasinghe, N.; Selva-Nayagam, D.
PURPOSE: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending schools for the blind in Sri Lanka, and to provide optical devices and ophthalmic treatment where indicated. METHODS: Two hundred and six children under 16 years from 13 schools for the blind in Sri Lanka were examined by a team of ophthalmologists and optometrists. Data were entered in the World Health Organization Prevention of Blindness Eye Examination Record for Childhood Blindness (WHO/PBL ERCB). RESULTS: Of the 206 children, 83.5% were blind (BL = Visual acuity [VA] <3/60), and 9.2% had severe visual impairment (SVI = VA <6/60 to 3/60 in the better eye). The major anatomical site of BL/SVI was the retina in 35.9% of cases, followed by the whole globe in 22.4% of cases. The major underlying aetiologies of BL/SVI were unknown in 43.8% of cases and hereditary in 37.5%. Avoidable causes of BL/SVI accounted for 34.9% of cases; retinopathy of prematurity made up the largest proportion of this subgroup. One third of the children required an optical device to improve their vision. CONCLUSION: Just over one third of the children in schools for the blind in Sri Lanka had potentially avoidable causes of BL/SVI. Vision could also be improved in a third of children. The data support the need to develop specialized pediatric ophthalmic services, particularly in the face of advancing neonatal life support in Sri Lanka, and the need for increased provision of optical support.
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A survey of visual impairment and blindness in children attending four schools for the blind in Cambodia
(Informa Healthcare, 2010) Sia, I.; Muecke, J.; Hammerton, M.; Ngy, M.; Kong, A.; Morse, A.; Holmes, M.; Piseth, H.; Hamilton, C.; Selva-Nayagam, D.
Purpose: To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending four schools for the blind in Cambodia and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment. Methods: Children<16 years of age were recruited from all 4 schools for the blind in Cambodia. Causes of visual impairment and blindness were determined and categorized using World Health Organization methods. Results: Of the 95 children examined, 54.7% were blind (BL) and 10.5% were severely visually impaired (SVI). The major anatomical site of BL/SVI was the lens in 27.4%, cornea in 25.8%, retina in 21% and whole globe in 17.7%. The major underlying etiologies of BL/SVI were hereditary factors (mainly cataract and retinal dystrophies) in 45.2%, undetermined/unknown (mainly microphthalmia and anterior segment dysgenesis) in 38.7% and childhood factors in 11.3%. Avoidable causes of BL/SVI accounted for 50% of the cases; 12.9% of the total were preventable with measles being the commonest cause (8.1% of the total); 37.1% were treatable with cataracts and glaucoma being the commonest causes (22.6% and 4.8% respectively). More than 35% of children required an optical device and 27.4% had potential for visual improvement with intervention. Conclusion: Half of the BL/SVI causes were potentially avoidable. The data support the need for increased coverage of measles immunization. There is also a need to develop specialized pediatric ophthalmic services for the management of surgically remediable conditions, to provide optometric, low vision and orientation and mobility services. Genetic risk counseling services also may be considered.
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A survey of visual impairment and blindness in children attending four schools for the blind in Cambodia
(Wiley-Blackwell, 2010) Sia, D.; Piseth, H.; Hamilton, C.; SELVA-NAYAGAM, D.; Muecke, J.; Hammerton, M.; Ngy, M.; Kong, A.; Morse, A.; Holmes, M.; 42nd Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists (20 Nov 2010 - 24 Nov 2010 : Adelaide, South Australia)
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A survey of visual impairment and blindness in children attending seven schools for the blind in Myanmar
(Informa Healthcare, 2009) Muecke, J.; Hammerton, M.; Aung, Y.; Warrier, S.; Kong, A.; Morse, A.; Holmes, M.; Yapp, M.; Hamilton, C.; Selva-Nayagam, D.
Purpose: To determine the causes of visual impairment and blindness amongst children in schools for the blind in Myanmar; to identify the avoidable causes of visual impairment and blindness; and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment where indicated. Methods: Two hundred and eight children under 16 years of age from all 7 schools for the blind in Myanmar were examined and the data entered into the World Health Organization Prevention of Blindness Examination Record for Childhood Blindness (WHO/PBL ERCB). Results: One hundred and ninety nine children (95.7%) were blind (BL = Visual Acuity [VA] < 3/60 in the better eye) and 3 had severe visual impairment (SVI = VA < 6/60 to 3/60 in the better eye). Most children had corneal abnormalities as the major anatomical site of SVI/BL (100, 49.5%), however the cause of SVI/BL was unknown in the majority (88, 43.6%). Measles keratitis was the commonest identifiable cause (17.4%) and 88 children had avoidable causes of SVI/BL (43.6%). Nearly 16% of children required an optical device and 24.2% required medical attention, with a potential for visual improvement through intervention in 15.8%. Conclusion: Nearly half of the children in schools for the blind in Myanmar had potentially avoidable causes of SVI/BL. With measles being both the commonest identifiable and commonest avoidable cause, the data supports the need for a measles immunization campaign. There is also a need for a dedicated pediatric eye care center with regular ophthalmology visits to the schools, and improved optometric, low vision and orientation and mobility services in Myanmar.
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A technique for multiple sample intraocular biopsy of choroidal lesions
(Lippincott, Williams & Wilkins, 2013) Greenwell, T.; Ebneter, A.; Gilhotra, J.
Open Access
Absence of lateral palpebral raphe in Caucasians
(Dove Medical Press Ltd, 2009) Goold, L.; Kakizaki, H.; Malhotra, R.; Selva-Nayagam, D.
Classical anatomical teaching reports the presence of the lateral palpebral raphe formed at the union in the preseptal and orbital parts of the orbicularis oculi muscle, or by the tendon adhering these to the underlying zygomatic bone. The lateral palpebral raphe has been shown to be absent in Asian cadavers. The current study uses both evidence from the anatomical dissection of five eyelids from three Caucasian cadavers, and histological assessment of the lateral canthus of 13 eyelids from seven Caucasian cadavers to illustrate the absence of the lateral palpebral raphe in Caucasian population.
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Accuracy of biopsy in subtyping periocular basal cell carcinoma
(Lippincott, Williams & Wilkins, 2015) Sun, M.; Wu, A.; Huilgo, S.; Selva, D.
PURPOSE: To determine the accuracy of initial biopsy in the diagnosis of basal cell carcinoma (BCC) histologic subtype. METHODS: Retrospective histopathologic review of patients with a diagnosis of primary periocular BCC from 2006 to 2013 inclusive. RESULTS: A total of 174 primary BCCs were identified. BCCs were classified as nodular, superficial, or aggressive (including mixed cases with an aggressive component). Punch biopsies were used in 41% of cases, while the remaining patients underwent shave or incision biopsies. The final histologic subtypes at excision were nodular (59%), superficial (7%), nodular and superficial (7%), and aggressive (51%). The overall concordance between the BCC subtype identified in the biopsy specimen and the subsequent excision specimen was 54%. In total, there were 51 cases (29%) of BCC, which included aggressive subtypes, of which 52% of initial biopsies failed to detect an aggressive component. There were 45 cases (26%) of mixed BCC, and an aggressive histologic subtype was present in 73% of these cases. CONCLUSIONS: The accuracy of initial biopsy for BCC histologic subtype at excision is highest for nodular BCC. For aggressive BCC, biopsy was able to detect the aggressive component in only 48% of cases. This may have implications for choice of treatment modality.
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Acute disseminated encephalomyelitis secondary to mycoplasma pneumoniae
(Blackwell Publishing Asia, 2009) Gupta, A.; Kimber, T.; Crompton, J.; Karagiannis, A.
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Acute intraocular inflammation after intravitreous injections of bevacizumab for treatment of neovascular age-related macular degeneration
(Elsevier Science Inc, 2008) Wickremasinghe, S.; Michalova, K.; Gilhotra, J.; Guymer, R.; Harper, C.; Wong, T.; Qureshi, S.
Purpose: Bevacizumab is an inhibitor of vascular endothelial growth factor widely used as an “off-label” treatment of neovascular age-related macular degeneration (AMD), despite the lack of clinical trial data on efficacy or safety of this drug. We describe acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Design: A retrospective case series. Participants: Patients with neovascular AMD treated with intravitreous injection of bevacizumab from clinical practices in 2 states (Victoria and South Australia) in Australia. Methods: We retrospectively reviewed cases of acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Main Outcome Measures: The detection and description of inflammation in a large cohort of patients. Results: There were 14 cases (11 women and 3 men), from a total of 1278 injections given. The mean age of patients was 83.7 years (range, 74–98). The majority had a prior injection of bevacizumab, with a mean number of injections of 2.7 (range, 1–6). Most patients presented within 24 hours of intravitreous injection, with rapid reduction in vision, but minimal discomfort. There were associated signs of ocular inflammation in the anterior and posterior segments of the eye. Visual acuity at presentation was substantially reduced compared with the preinjection acuity, although the vision rapidly improved with treatment over a period of 7–25 days toward preinjection visual acuity. Conclusions: Intravitreous injection of bevacizumab for the treatment of neovascular AMD may be associated with acute intraocular inflammation. Differentiation from infectious endophthalmitis is important for appropriate management of this condition.
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Acute post-operative rhinosinusitis following endonasal dacryocystorhinostomy
(Nature Publishing Group, 2013) Shams, P.; Selva-Nayagam, D.
Purpose: To investigate the incidence and risk factors for acute rhinosinusitis (ARS) following endoscopic dacryocystorhinostomy (EnDCR). Methods: Retrospective single-surgeon interventional case series, including 196 consecutive patients undergoing 203 endonasal DCR, with clinical and radiological evidence of nasolacrimal duct or common canalicular obstruction. Pre-operative lacrimal and sinonasal clinical assessment and imaging, intraoperative endoscopic video recording, and post-operative clinical and endoscopic findings were analysed for cases of ARS occurring within the first 4 weeks following DCR among patients with and without a past history of chronic rhinosinusitis (CRS). Surgical complications and outcomes at 12 months and management of ARS are reported. Results: Three patients (1.5%) developed ARS within the first 5 post-operative days, none of which had experienced peri-operative complications and all had a past history of CRS. The rate of CRS in this cohort of 196 patients was 10.2% (n=20), of which 15% (n=3) developed ARS, although none had symptoms of CRS at the time of surgery; one had undergone previous sinus surgery. Presenting symptoms of ARS included facial pain, tenderness over the affected sinus, and nasal discharge; all patients responded to oral antibiotic therapy. Discussion: The rate of ARS following EnDCR was 1.5%. In those with a prior history of CRS, it was 15% (P=0.009). ARS developed within the first post-operative week among patients with a past history of CRS, who were asymptomatic at the time of surgery, and responded to oral antibiotics. CRS may be a risk factor for the development of post-operative ARS.

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