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Biomedical subjects

Peter McCluskey

Publications and source records attributed to Peter McCluskey.

13 recordsLinked to original sources
PubMed2006

The ocular manifestations of inflammatory bowel disease.

PURPOSE OF REVIEW: The purpose of this review is to present the literature on the ocular complications of inflammatory bowel disease, their pathogenesis, manifestation and treatment options. In particular, the literature pertaining to recently available treatments will be reviewed. RECENT FINDINGS: Although the pathogenesis of inflammatory bowel disease remains incompletely understood, treatment options for ocular and systemic disease have expanded with the introduction of newer steroid-sparing agents such as mycophenolate mofetil and a new class of immunomodulatory agents targeting cytokines, in particular infliximab, a monoclonal antibody directed against tumour necrosis factor-alpha. SUMMARY: That inflammatory bowel disease can have ocular manifestations has been known for over 80 years. Knowing of their occurrence and treatment options enables the treating clinician to recognize their cause and treat them appropriately.

Anti-Inflammatory Agents↗
PubMed2006

Intravitreal steroids in the management of macular oedema.

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.

Dexamethasone↗
PubMed2006

Endogenous Candida endophthalmitis.

Intraocular Candida infections, although uncommon, represent an important clinical problem owing to the potential for visual loss, which can be bilateral. Candida chorioretinitis and endophthalmitis are complications of systemic candidiasis with extension of the fungal pathogens to the uvea and retina. Early diagnosis and prompt management significantly affect the visual prognosis for these patients. This review evaluates the current literature on Candida endophthalmitis and includes discussion on presentation, diagnosis and management strategies. New systemic and intravitreal antifungal agents are also reviewed in the context of the management of intraocular fungal infection.

Antifungal Agents↗
PubMed2005

Outcome of intravitreal triamcinolone in uveitis.

PURPOSE: To report the short-term outcome of intravitreal triamcinolone acetate (TA) in the treatment of uveitic cystoid macular edema (CME). DESIGN: Retrospective noncomparative (nonrandomized, uncontrolled) interventional case series. PARTICIPANTS: Sixty-five eyes of 54 patients with uveitis-related CME inadequately responsive to treatment combinations of oral corticosteroid, periocular orbital floor corticosteroid injections, and second-line immunosuppressive agents. INTERVENTION: Intravitreal injection of 4 mg/0.1 ml of TA. MAIN OUTCOME MEASURES: Visual acuity (VA), intraocular pressure (IOP), levels of inflammation, and immunosuppressive therapy were assessed. Other potential complications, including cataract progression, vitreous hemorrhage, endophthalmitis, and retinal detachment (RD), were looked for. RESULTS: The mean follow-up was 8.0 months (range, 3-51), and the mean improvement of VA after intravitreal TA was 0.26 (from 0.65 to 0.39 logarithm of the minimum angle of resolution; Snellen, 6/24-6/12, approximately). This occurred at a mean of 4 weeks (range, 1-30). The improvement in VA was more significant if the duration of CME before intravitreal TA was < or =12 months (P = 0.006) and if patients were < or =60 years old (P = 0.005). Patients with the worst vision before treatment also improved the least. The most important side effect was raised IOP (mean rise, 10.3 mmHg), with 28 eyes (43.1%) experiencing an IOP rise of >10 mmHg. Patients younger than 40 years were more likely to experience this IOP rise than those older than 40. Thirty-three eyes (51%) were treated with antiglaucoma medications, with a mean duration of treatment of 17.4+/-13.3 weeks, and no patient required trabeculectomy or lost vision. The dosage of oral corticosteroids and/or second-line immunosuppressive medication was reduced or stopped altogether in 18 of 33 eyes (54.5%) during the study period. There were no cases of injection-related vitreous hemorrhage, endophthalmitis, or RD. CONCLUSIONS: In patients with uveitic CME, intravitreal TA can effectively reduce CME and improve VA and, in some eyes, allows the cessation and/or reduction of immunosuppressive therapy. The period of effectivity varies in different patients and, in some eyes, is limited. Treatment was associated in 43.1% with a rise in IOP, which was transient and treatable medically.

Adolescent↗
PubMed2005

Scedosporium prolificans sclerokeratitis 10 years after pterygium excision with adjunctive mitomycin C.

Scedosporium prolificans is an unusual infection, especially following pterygium surgery. A 63-year-old man who developed an uncomfortable, red right eye 10 years after pterygium surgery with adjunctive mitomycin C is described. To the best of the authors' knowledge, this is the first reported case of S. prolificans sclerokeratitis following pterygium surgery with adjunctive mitomycin C.

Amphotericin B↗
PubMed2005

Diagnostic vitreous biopsy in patients with uveitis: a useful investigation?

PURPOSE: To assess whether the results of microbial and cytological investigations of vitreous biopsy specimens are useful in the management of patients with intraocular inflammation. METHOD: A retrospective review of the medical records of 59 consecutive patients from consulting rooms, outpatient clinics and inpatient consultation who underwent intravitreal sampling between January 1997 and December 2003. Results of the biopsies were examined to determine if they altered management of the patient. RESULTS: The clinical diagnosis was correct in 37 of 59 patients (62.7%) with ocular inflammation. The organism was identified in 50% (7/14) of vitreous biopsies in patients with postoperative endophthalmitis. Of patients with endogenous bacterial endophthalmitis 16.7% (1/6) had the diagnosis confirmed by vitreous tap and 83.3% (5/6) had positive cultures from other sites that provided the diagnosis. Of the fungal endophthalmitis 80% (4/5) grew the fungus from the vitreous biopsy. Viral polymerase chain reaction identified the causative organism in 87.5% (7/8) of patients with clinical diagnosis of viral infection. 30.8% (4/13) vitreous biopsies in patients with clinically suspected masquerade syndromes were diagnosed as lymphoma. Vitreous biopsy results altered management significantly in seven (11.9%) patients. These patients included toxoplasmosis that was thought to be viral retinitis; malignant melanoma thought to be fungal endophthalmitis; chronic inflammation secondary to retinal detachment that was thought to be a neoplasm; three patients with infective endophthalmitis thought to be idiopathic uveitis and a patient with known lung carcinoma thought to have metastases who had lymphoma. In 67.8% (40/59) the vitreous sample helped to either confirm the diagnosis or exclude an infective cause. Complications from vitrectomy were hypotony (1/29) and retinal detachment (1/29). CONCLUSION: Clinical diagnosis based on examination findings and vitreous biopsy is highly accurate. Vitreous sampling altered the management of seven of 59 patients. Vitreous biopsy is a safe and useful method for diagnosing and excluding malignancy and infection in patients with ocular inflammation. Viral polymerase chain reaction is highly sensitive and accurate. The sensitivity of microbiological culture techniques for bacteria and fungi limits their usefulness.

Adult↗
PubMed2004

Methotrexate therapy for ocular cicatricial pemphigoid.

PURPOSE: To report the use of methotrexate therapy as first-line systemic therapy in the treatment of ocular-cicatricial pemphigoid and drug-induced ocular-cicatricial pemphigoid. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Twelve patients with ocular-cicatricial pemphigoid and 5 patients with drug-induced ocular-cicatricial pemphigoid treated with low-dose oral methotrexate as the sole systemic agent. In 14 of the 17 patients, methotrexate was the first systemic agent used. METHODS: Clinical data abstracted from patient medical records. MAIN OUTCOME MEASURES: Visual acuity, conjunctival inflammation, progression of cicatrization, and treatment-related side effects. RESULTS: After a mean follow-up duration of 30.2 months (range, 6-78 months), complete control or suppression, or both, of conjunctival inflammation was achieved in 89% of eyes with ocular-cicatricial pemphigoid and in 100% of eyes with drug-induced ocular-cicatricial pemphigoid using methotrexate monotherapy as the first-line systemic agent. Progression of conjunctival cicatrization was prevented in 72% of eyes with ocular-cicatricial pemphigoid and 90% of eyes with drug-induced ocular-cicatricial pemphigoid. Visual acuity was maintained or improved in 85% of total eyes treated with methotrexate monotherapy, and a final visual acuity of 6/18 or better was achieved in 74% of the eyes. Methotrexate therapy was well tolerated, with 92% of patients maintained on continued treatment experiencing no side effects. The most common side effects were gastrointestinal (50%), and most (78%) were reversible on dose reduction. In 4 of 17 cases, methotrexate was ceased as a result of possible treatment-related side effects. CONCLUSIONS: Low-dose oral methotrexate monotherapy is both highly efficacious and well tolerated as the first-line systemic agent in the treatment of ocular-cicatricial pemphigoid and drug-induced ocular-cicatricial pemphigoid.

Aged↗
PubMed2004

Expression of toll-like receptor 4 and its associated lipopolysaccharide receptor complex by resident antigen-presenting cells in the human uvea.

PURPOSE: To investigate the in vivo expression of toll-like receptor 4 (TLR4) and its associated lipopolysaccharide (LPS) receptor complex in the human eye. METHODS: Normal human ocular tissues were evaluated for in vivo TLR4, MD-2, and CD14 mRNA and protein expression by RT-PCR and immunohistochemistry, respectively. The distribution patterns and phenotypes of the cells expressing these proteins were further characterized by confocal microscopy and double-label immunofluorescence studies. RESULTS: Normal human uvea, retina, sclera, and conjunctiva constitutively expressed TLR4, MD-2, and CD14 mRNA. The protein expression of these molecules was restricted, however, to resident antigen-presenting cells (APCs) in the normal human uvea, consisting mainly of HLA-DR(+) dendritic cells (DCs). These APCs endowed with the complete LPS receptor complex appeared to be strategically positioned in perivascular and subepithelial locations for surveying blood-borne or intraocular LPS. In contrast, other cell types of the normal human cornea, conjunctiva, retina, and sclera did not express TLR4/MD-2 protein in vivo as detectable by immunohistochemistry. CONCLUSIONS: The present study demonstrates for the first time that resident APCs in the normal human uvea express TLR4 and its associated LPS receptor complex. This has significant implications for the understanding of normal ocular immunity as well as unraveling the potential role of Gram-negative bacteria in the pathogenesis of acute anterior uveitis (AAU).

Aged↗
PubMed2003

Retinal detachment in cytomegalovirus retinitis: intravenous versus intravitreal therapy.

PURPOSE: To compare the rate of retinal detachment in a group of patients treated with intravitreal ganciclovir to the rate of retinal detachment in a group of patients treated with systemic ganciclovir. METHODS: A retrospective non-randomized comparative case series was conducted. The participants were 186 consecutive patients with cytomegalovirus (CMV) retinitis treated at two centres over the period from June 1990 to May 1997. Of the 186, 133 patients had systemic therapy of whom 113 had intravenous ganciclovir or foscarnet and 20 had oral ganciclovir, and 53 patients had intravitreal induction and maintenance therapy. The main outcome measure was the rate of retinal detachment, which was calculated using person-months-at-risk denominators. The effect measure used in the main comparative analysis was the hazard ratio obtained from multiple regression using the Cox proportional hazards model. RESULTS: Retinal detachment occurred in three of 53 patients in the intravitreal therapy group, one of 20 patients receiving oral maintenance therapy and 21 of 113 patients receiving intravenous maintenance therapy. The risk of retinal detachment with systemic therapy was 14-fold higher than with intravitreal therapy (P < 0.001)and up to fourfold higher with oral maintenance therapy. CONCLUSIONS: Intravitreal therapy offers a significant advantage over systemic therapy in the treatment of CMV retinitis by substantially reducing the risk of CMV-related retinal detachment.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Scleritis.

Scleritis is typically a severe painful inflammatory process centered in the sclera that may involve the cornea, adjacent episclera, and underlying uvea; it poses a significant threat to vision. Careful clinical history taking, detailed ocular examination, appropriate investigation for ocular disease with or without underlying systemic disease, and timely intervention with the use of immunosuppressant drugs when necessary, has improved the long-term outcome for patients with this disease.

Humans↗
PubMedDate not supplied

The eye in systemic inflammatory diseases.

Systemic inflammatory diseases commonly affect the sclera, cornea, retina, and orbit, and can pose a serious threat to sight. They encompass both primary and secondary vasculitic disorders and specific granulomatous inflammatory conditions. As well as direct eye involvement from the systemic inflammatory process, there can be signs of ocular ischaemia due to carotid or ophthalmic arteritis, hypertensive retinopathy, and ocular complications such as chloroquine maculopathy related to anti-inflammatory drug treatment. Additionally, systemic infection relating to the eye, either as the result of primary infective disease processes or infection secondary to immunosuppression, might be mistaken as endogenous intraocular inflammation. Infection can closely mimic the ocular signs of endogenous inflammation, and in selected patients (such as those who have been immunosuppressed to treat vasculitis and who additionally have had invasive surgery, indwelling intravenous catheters, or systemic sepsis), it might be necessary to specifically exclude infection by the sampling and culturing of intraocular fluids and tissue.

Diagnosis, Differential↗
PubMedDate not supplied

Visual outcomes for optic nerve sheath fenestration in pseudotumour cerebri and related conditions.

BACKGROUND: To determine the efficacy and safety of optic nerve sheath fenestration, and to identify factors predicting visual field (VF) and visual acuity (VA) in patients with progressive pseudotumour cerebri syndrome. METHODS: This retrospective observational case series studied 51 eyes of 32 patients with pseudotumour cerebri syndrome, by chart review and comparison of preoperative and postoperative examinations. Main outcome measures included VF, VA and complications. RESULTS: Postoperative VF mean deviation scores improved (P = 0.03) within 6 months when compared with preoperative VF. Multiple regression analysis demonstrated that eyes with mean deviation > or = -20 dB were associated with improved or stabilized VA at 6 months, odds ratio 7.5 and confidence interval (1.2, 46.1), P = 0.03. Eyes with VF defects outside 10 degrees of fixation were associated with improved or stabilized VF at 6 months odds ratio 9.7, 95% confidence interval 1.1, 85.9, P = 0.04. Five patients developed self-limiting complications from surgery. CONCLUSIONS: Optic nerve sheath fenestration is safe and effective in stabilizing or improving VF and VA in the short to medium term. Patients with mild VF loss improved following surgery, and patients with severe VF loss stabilized following surgery.

Adolescent↗