Vernal keratoconjunctivitis.
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Adolescent↗
Biomedical subjects
Peter J McCluskey
Publications and source records attributed to Peter J McCluskey.
Ocular cicatricial pemphigoid: manifestations and management.
Ocular cicatricial pemphigoid (OCP) is a chronic, progressive cicatrizing inflammatory disease of presumed autoimmune etiology affecting the mucous membranes and skin. It has sight-threatening ocular manifestations and potentially life-threatening extraocular manifestations. The ocular signs include: chronic cicatricial conjunctivitis, progressive conjunctival fibrosis, and corneal epitheliopathy. Systemic immunomodulatory therapy is the treatment of choice for controlling disease activity and limiting progression, given the systemic nature of the disease and the poor efficacy of current local or topical therapies. Systemic cyclophosphamide with short-term adjunctive high-dose prednisolone is the preferred treatment for severe and/or rapidly progressing OCP. Oral low-dose weekly methotrexate is a useful first-line treatment for mild-to-moderate OCP. The management of OCP requires a multidisciplinary approach to optimize the care of these patients.
Cicatrix↗
Surgeons' perceptions of their patients' priorities.
PURPOSE: To compare cataract surgeons' predictions of patient responses to patients' actual responses on 13 factors that are important to patients about to have cataract surgery and are likely to affect their satisfaction. SETTING: Day-stay cataract surgery units at a large private hospital and a large public hospital. METHOD: Patients (private and public) were asked to rate the importance of 13 factors regarding their cataract treatment. All cataract surgeons who regularly treated cataract patients in a large metropolitan city were randomized to a public or private group and sent the same 13 factors. The surgeons were asked to rate how important each factor is to their public or private patients, as appropriate. RESULTS: Eighty-one patients and 77 doctors responded to the survey. Overall, doctors predicted that all items would be more important to private patients than to public patients, even though no significant difference existed between the patient groups. Doctors correctly identified public patients' priorities but underestimated the magnitude of overall importance. In contrast, doctors recognized the magnitude of overall importance to private patients but misjudged many priorities. Doctors underestimated the importance to patients of nonsurgical characteristics such as seeing the same doctor, having a pleasant location for appointments, and waiting time for surgery. CONCLUSIONS: This study demonstrates significant discordance between patients' priorities when having cataract surgery and their doctors' perception of those priorities. These differences could be explained by doctors' stereotypes of public patients and insufficient appreciation of the nonmedical aspects of patient care.
Attitude of Health Personnel↗
Progressive visual loss in a patient with presumed temporal arteritis despite treatment: how to make the diagnosis.
Giant cell (temporal) arteritis is a severe potentially fatal systemic vasculitis characterized by focal involvement of the cranial arteries resulting in ischaemic arterial occlusion. The case is presented of a 75-year-old woman with presumed giant cell arteritis and normal bilateral temporal artery biopsies. Despite a seemingly adequate course of systemic steroid therapy, the patient developed sudden catastrophic vision loss. Cerebral angiography and ultrasonography were useful investigations to determine the most appropriate artery to biopsy to confirm the diagnosis of giant cell arteritis.
Aged↗
Cataract surgery in Australia: a profile of patient-centred outcomes.
BACKGROUND: Few studies have addressed quality of life or satisfaction outcomes for patients undergoing cataract surgery, particularly in Australia. The purpose of this study was to describe a sample of patients undergoing cataract surgery in typical metropolitan practices in Sydney, with a particular focus on the impact upon quality of life and satisfaction with vision. METHODS: One hundred and eleven patients were recruited prior to surgery and followed through 3 months postoperatively. Patients reported basic demographic information, VF-14 visual disability and SF-36 quality of life information, along with the degree of satisfaction and trouble with vision they experienced. Surgeons' records provided information about type and severity of cataract, refractive error, ocular comorbidity and visual acuity. RESULTS: Patients enjoyed strongly significant improvement in visual acuity, disability, trouble and satisfaction with vision, with a median postoperative Snellen acuity of 6/7.5, and 82% within 1 D refraction. Not wearing glasses was the most commonly stated patient goal for undergoing surgery. Prior to surgery 23% of all driving patients did so illegally due to poor vision; after surgery 21% of non-drivers began driving again, all legally. Nonetheless, quality of life did not improve. Those who failed to achieve improvements in satisfaction with vision were more likely to be female, have lower educational attainment or have high visual function preoperatively. Change in visual acuity was not predictive. CONCLUSIONS: The findings from this study indicate that cataract surgery outcomes in Australia compare well with international standards, and emphasize the inadequacy of visual acuity to measure relevant surgical outcomes. Increased preoperative counselling may be required in those groups less likely to attain high levels of satisfaction. Finally, the role of cataract surgery to improve quality of life must be investigated further, as this is the ultimate goal of the procedure.
Aged↗
Public versus private patient priorities and satisfaction in cataract surgery.
BACKGROUND: Despite strong stereotypes of differences, few studies have compared private and public patient priorities and satisfaction, and none in the context of cataract surgery. The objective of this study was to compare samples of private and public patients undergoing day-stay cataract surgery. METHODS: Forty-two public patients and 39 private patients were asked to rate the importance of 13 domains that prior research has shown to influence patient satisfaction. Patients were also asked about their waiting time, amount of information they received, and current and expected VF-14 functional ability. One month after surgery, patients recorded their satisfaction with each of the 13 domains. RESULTS: Public patients waited ninefold longer for surgery and had lower preoperative visual function. Nonetheless both groups expected, and achieved, the same level of postoperative outcome. Although 90% of private patients were satisfied with the information they received regarding the surgery, 45% of public patients wanted more. There were significant differences in priorities between private and public patients. After surgery, public patients were less satisfied than private patients, although when accounting for the importance as well as satisfaction of each factor, the level of satisfaction between groups was not different. CONCLUSIONS: The dearth of information received by public patients raises important questions whether their surgery decision was sufficiently individualized or adequately consented. Patient satisfaction is an important health outcome, and understanding both the domains of satisfaction, as well as their relative importance to patients, is necessary to improve the overall quality of patient care.
Aged↗
Matrix metalloproteinases and tissue inhibitors of matrix metalloproteinases in the human lens: implications for cortical cataract formation.
PURPOSE: To characterize the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in human cortical cataract and to determine whether there is a correlation with the localization of cortical cataract. To evaluate the expression and activity of MMPs and TIMPs after cytokine and UV-B exposure in a human lens epithelial cell line. METHODS: Twenty-eight human donor eyes with cortical cataract and 21 normal human donor eyes were photographed. Thirteen cortical cataract and six normal lenses were immunohistochemically analyzed for MMP-1, -2, -3, and -9 and TIMP-1, -2, and -3. Twelve fresh cortical cataract and 12 normal lenses were divided into quadrants to quantify, by ELISA, the expression of MMP-1, -2, -3, and -9 and TIMP-1. Three fresh cortical cataract and three control lenses were assessed for MMP-1, -2, and -9 activity by SDS-PAGE zymography. Human lens epithelial cells (HLE-SRA-01/04) were exposed to proinflammatory cytokines and UV-B radiation to determine the protein expression profiles of MMP-1, -2, -3, and -9 and TIMP-1 and -2. RESULTS: Immunohistochemical analysis revealed specific localization of MMP-1 within lens epithelium and cortical lens fibers of cortical cataract. Normal lenses had equally low MMP-1, -2, -3, and -9 and TIMP-1, -2, and -3 immunoreactivity, expression, and activity in all lens quadrants. IL-1 and TNF-alpha upregulated the expression of MMP-2, -3, and -9, and UV-B upregulated the expression of MMP-1 in the SRA-01/04 HLE cell line. CONCLUSIONS: This is the first study to localize the expression of MMP-1 in cataracts with clinically observed opacification in vivo and to examine the expression induced by UV-B, in vitro.
Adult↗
Bacterial contamination of the anterior chamber during phacoemulsification cataract surgery.
PURPOSE: To determine the incidence of bacterial contamination of the anterior chamber after phacoemulsification cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia. METHODS: Ninety-eight consecutive eyes of 96 patients having phacoemulsification cataract surgery with IOL implantation were included in this prospective study. Two intraoperative anterior chamber aspirates were obtained from each patient, 1 taken at the start and the other at the conclusion of surgery. In addition, preoperative and postoperative conjunctival swabs were acquired. The 4 specimens were cultured using direct culturing techniques under aerobic and anaerobic conditions for 14 days. No preoperative antibiotics were used. RESULTS: The incidence of intraoperative anterior chamber contamination was 0% (95% confidence interval, 0%-3.7%) as all intraoperative anterior chamber samples proved culture negative. Sixty-five percent of the preoperative conjunctival swabs were positive for growth, with corynebacteria, coagulase-negative staphylococci, and Propionibacterium acnes being the most frequently cultured organisms. Sixteen percent of the postoperative conjunctival swabs were positive for growth, with corynebacteria and coagulase-negative staphylococci being the most common bacteria. One patient developed culture-positive postoperative endophthalmitis; using pulsed-field gel electrophoresis for further typing, the implicated Staphylococcus epidermidis was indistinguishable from that isolated from the patient's preoperative conjunctival swab. CONCLUSIONS: The bacterial contamination rate of the anterior chamber after phacoemulsification and IOL implantation was extremely low. Additional findings support the conjunctiva as being a primary source of bacteria causing postoperative endophthalmitis as well as the ability of povidone-iodine to reduce the conjunctival bacterial load.
Aged↗
Methotrexate-induced optic neuropathy.
A 53-year-old Caucasian woman with long-standing, well controlled, severe rheumatoid arthritis, treated with methotrexate, salazopyrin, naprosyn, prednisone and plaquenil, presented with progressive visual loss in each eye. She had a past history of non-necrotizing anterior scleritis that was treated with increased doses of prednisone. She developed left then right central scotomas, reduced vision and optic atrophy. Eventually a diagnosis of methotrexate-induced optic atrophy was made.
Antirheumatic Agents↗
Lens dislocation in Marfan syndrome: potential role of matrix metalloproteinases in fibrillin degradation.
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Adult↗
Acute anterior uveitis and HLA-B27.
Acute anterior uveitis is the most common form of uveitis. HLA-B27-associated acute anterior uveitis is a distinct clinical entity that has wide-ranging medical significance due to its ocular, systemic, immunologic, and genetic features. The association between HLA-B27 and the spectrum of HLA-B27-associated inflammatory diseases remains one of the strongest HLA-disease associations known to date. This review examines acute anterior uveitis with particular focus on HLA-B27-associated acute anterior uveitis, including the epidemiology, immunopathology, association with HLA-B27 and its subtypes, clinical features, complications, prognosis, and potential new therapies such as anti-TNFalpha therapy and oral HLA-B27-peptide tolerance. There have been substantial recent advances in both clinical and basic scientific research in this field, including studies of the various animal models of acute anterior uveitis and the HLA-B27 transgenic animals, and these are summarized in this review. To the ophthalmologist, HLA-B27-associated acute anterior uveitis is an important clinical entity that is common, afflicts relatively young patients in their most productive years, and is associated with significant ocular morbidity due to its typically recurrent attacks of inflammation and its potentially vision-threatening ocular complications. Furthermore, to the ophthalmologist and the internist, HLA-B27-associated acute anterior uveitis is also of systemic importance due to its significant association with extraocular inflammatory diseases.
Acute Disease↗
Which way forward for treatment of severe ocular inflammation?
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Anti-Inflammatory Agents↗