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Abstract
Considerable advances have been made in our understanding of age-related macular degeneration (AMD) genetics over the past decade. The genetic associations discovered to date are estimated to account for approximately half of AMD heritability, and functional studies of these variants have revealed new insights into disease pathogenesis, leading to the development of potential novel therapies. There is furthermore growing interest in genetic testing for predicting an individual's risk of AMD and offering personalised preventive or therapeutic treatments. We review the progress made so far in AMD genetics and discuss the possible applications for genetic testing.
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Affiliation(s)
| | - A Lotery
- Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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McKibbin M, Devonport H, Gale R, Gavin M, Lotery A, Mahmood S, Patel PJ, Ross A, Sivaprasad S, Talks J, Walters G. Aflibercept in wet AMD beyond the first year of treatment: recommendations by an expert roundtable panel. Eye (Lond) 2016; 29 Suppl 1:S1-S11. [PMID: 26156564 PMCID: PMC4506328 DOI: 10.1038/eye.2015.77] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This paper provides expert recommendations on administration of aflibercept in wet age-related macular degeneration (AMD) after Year 1 (Y1), based on a roundtable discussion held in London, UK in November 2014. The goals of treatment after Y1 are to maintain visual and anatomical gains whilst minimising treatment burden and using resources effectively. The treatment decision should be made at the seventh injection visit (assuming the label has been followed) in Y1, and three approaches are proposed: (a) eyes with active disease on imaging/examination but with stable visual acuity (VA) at the end of Y1 should continue with fixed 8-weekly dosing; (b) eyes with inactive disease on imaging/examination and stable VA should be managed using a 'treat and extend' (T&E) regimen. T&E involves treating and then extending the interval until the next treatment, by 2-week intervals, to a maximum of 12 weeks, provided the disease remains inactive. If there is new evidence of disease activity, treatment is administered and the interval to the next treatment shortened; and (c) if there has been no disease activity for ≥3 consecutive visits, a trial of monitoring without treatment may be appropriate, initiated at the end of Y1 or at any time during Y2. Where possible, VA testing, OCT imaging and injection should be performed at the same visit. The second eye should be monitored to detect fellow eye involvement. In bilateral disease, the re-treatment interval should be driven by the better-seeing eye or, if the VA is similar, the eye with the more active disease.
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Affiliation(s)
- M McKibbin
- Ophthalmology Department, St James's University Hospital, Leeds, UK
| | - H Devonport
- Ophthalmology Department, Bradford Royal Infirmary, Bradford, UK
| | - R Gale
- Ophthalmology Department, The York Hospital, York, UK
| | - M Gavin
- Ophthalmology Department, NHS Greater Glasgow and Clyde, UK
| | - A Lotery
- Southampton General Hospital, Southampton, UK
| | - S Mahmood
- 1] Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK [2] Centre for Ophthalmology & Vision Sciences, Institute of Human Development, University of Manchester, Manchester, UK
| | - P J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - A Ross
- Bristol Eye Hospital, Bristol, UK
| | - S Sivaprasad
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - J Talks
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - G Walters
- Department of Ophthalmology, Harrogate District Hospital, Harrogate, UK
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Yang Y, Bailey C, Holz FG, Eter N, Weber M, Baker C, Kiss S, Menchini U, Ruiz Moreno JM, Dugel P, Lotery A. Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants. Eye (Lond) 2015; 29:1240. [PMID: 26353919 DOI: 10.1038/eye.2015.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Warwick A, Gibson J, Sood R, Lotery A. A rare penetrant TIMP3 mutation confers relatively late onset choroidal neovascularisation which can mimic age-related macular degeneration. Eye (Lond) 2015; 30:488-91. [PMID: 26493035 DOI: 10.1038/eye.2015.204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/03/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To perform a genotype-phenotype correlation for three patients heterozygous for a missense mutation in the tissue inhibitor of metalloproteinase 3 (TIMP3) gene. METHODS Retrospective, observational case series. The medical records and photographs were reviewed for three patients diagnosed at the time with neovascular age-related macular degeneration (AMD). All were later found to carry a predicted C113G mutation in the TIMP3 gene, other known mutations in which are associated with Sorsby's fundus dystrophy. RESULTS All three patients developed drusen and bilateral choroidal neovascularisation with subsequent disciform scarring and atrophy. Visual acuity rapidly deteriorated to <6/60 in both eyes. The age of onset varied from 56 to 64 years and the interval to contralateral eye involvement varied from 4 to 6 years. Two of the three patients had a family history of AMD. All three patients were heterozygous for the C113G nucleotide change, resulting in a Ser38Cys change at the N terminus of the TIMP3 protein. CONCLUSION This case series suggests the C113G TIMP3 variant may represent a novel highly penetrant mutation causing choroidal neovascularisation of relatively late onset for Sorsby's fundus dystrophy, mimicking early onset AMD.
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Affiliation(s)
- A Warwick
- Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Eye Unit, University Southampton NHS Trust, Southampton, UK
| | - J Gibson
- Centre for Biological Science, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - R Sood
- Centre for Biological Science, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, UK
| | - A Lotery
- Clinical Neurosciences Research Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Eye Unit, University Southampton NHS Trust, Southampton, UK
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Yang Y, Bailey C, Holz FG, Eter N, Weber M, Baker C, Kiss S, Menchini U, Ruiz Moreno JM, Dugel P, Lotery A. Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants. Eye (Lond) 2015; 29:1173-80. [PMID: 26113503 PMCID: PMC4565956 DOI: 10.1038/eye.2015.98] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/06/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Diabetic macular oedema (DMO) is a leading cause of blindness in working-age adults. Slow-release, nonbioerodible fluocinolone acetonide (FAc) implants have shown efficacy in the treatment of DMO; however, the National Institute for Health and Care Excellence recommends that FAc should be used in patients with chronic DMO considered insufficiently responsive to other available therapies only if the eye to be treated is pseudophakic. The goal of this analysis was to examine treatment outcomes in phakic patients who received 0.2 μg/day FAc implant. METHODS This analysis of the phase 3 FAME (Fluocinolone Acetonide in Diabetic Macular Edema) data examines the safety and efficacy of FAc implants in patients who underwent cataract extraction before (cataract before implant (CBI) group) or after (cataract after implant (CAI) group) receiving the implant. The data were further examined by DMO duration. RESULTS Best corrected visual acuity (BCVA) after 36 months was comparable in the CAI and CBI groups. Both the percentage of patients gaining ≥ 3 lines of vision and mean change in BCVA letter score were numerically greater in the CAI group. In addition, most patients who underwent cataract surgery experienced a net gain in BCVA from presurgery baseline as well as from original study baseline. CONCLUSIONS These data support the use of 0.2 μg/day FAc implants in phakic as well as in pseudophakic patients. These findings will serve as a pilot for design of future studies to evaluate the potential protective effect of FAc implants before cataract surgery in patients with DMO and cataract.
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Affiliation(s)
- Y Yang
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - C Bailey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - F G Holz
- University of Bonn, Bonn, Germany
| | - N Eter
- University of Muenster Medical Center, Muenster, Germany
| | - M Weber
- University Hospital of Nantes, Nantes, France
| | - C Baker
- Paducah Retinal Center, Paducah, KY, USA
| | - S Kiss
- Weill Cornell Medical College, New York, NY, USA
| | - U Menchini
- Università degli Studi di Firenze, Firenze, Italy
| | | | - P Dugel
- Retinal Consultants of Arizona, Phoenix, AZ, USA
| | - A Lotery
- University of Southampton, Southampton, UK
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Amoaku WM, Chakravarthy U, Gale R, Gavin M, Ghanchi F, Gibson J, Harding S, Johnston RL, Kelly SP, Kelly S, Lotery A, Mahmood S, Menon G, Sivaprasad S, Talks J, Tufail A, Yang Y. Defining response to anti-VEGF therapies in neovascular AMD. Eye (Lond) 2015; 29:721-31. [PMID: 25882328 DOI: 10.1038/eye.2015.48] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/01/2015] [Indexed: 11/09/2022] Open
Abstract
The introduction of anti-vascular endothelial growth factor (anti-VEGF) has made significant impact on the reduction of the visual loss due to neovascular age-related macular degeneration (n-AMD). There are significant inter-individual differences in response to an anti-VEGF agent, made more complex by the availability of multiple anti-VEGF agents with different molecular configurations. The response to anti-VEGF therapy have been found to be dependent on a variety of factors including patient's age, lesion characteristics, lesion duration, baseline visual acuity (VA) and the presence of particular genotype risk alleles. Furthermore, a proportion of eyes with n-AMD show a decline in acuity or morphology, despite therapy or require very frequent re-treatment. There is currently no consensus as to how to classify optimal response, or lack of it, with these therapies. There is, in particular, confusion over terms such as 'responder status' after treatment for n-AMD, 'tachyphylaxis' and 'recalcitrant' n-AMD. This document aims to provide a consensus on definition/categorisation of the response of n-AMD to anti-VEGF therapies and on the time points at which response to treatment should be determined. Primary response is best determined at 1 month following the last initiation dose, while maintained treatment (secondary) response is determined any time after the 4th visit. In a particular eye, secondary responses do not mirror and cannot be predicted from that in the primary phase. Morphological and functional responses to anti-VEGF treatments, do not necessarily correlate, and may be dissociated in an individual eye. Furthermore, there is a ceiling effect that can negate the currently used functional metrics such as >5 letters improvement when the baseline VA is good (ETDRS>70 letters). It is therefore important to use a combination of both the parameters in determining the response.The following are proposed definitions: optimal (good) response is defined as when there is resolution of fluid (intraretinal fluid; IRF, subretinal fluid; SRF and retinal thickening), and/or improvement of >5 letters, subject to the ceiling effect of good starting VA. Poor response is defined as <25% reduction from the baseline in the central retinal thickness (CRT), with persistent or new IRF, SRF or minimal or change in VA (that is, change in VA of 0+4 letters). Non-response is defined as an increase in fluid (IRF, SRF and CRT), or increasing haemorrhage compared with the baseline and/or loss of >5 letters compared with the baseline or best corrected vision subsequently. Poor or non-response to anti-VEGF may be due to clinical factors including suboptimal dosing than that required by a particular patient, increased dosing intervals, treatment initiation when disease is already at an advanced or chronic stage), cellular mechanisms, lesion type, genetic variation and potential tachyphylaxis); non-clinical factors including poor access to clinics or delayed appointments may also result in poor treatment outcomes. In eyes classified as good responders, treatment should be continued with the same agent when disease activity is present or reactivation occurs following temporary dose holding. In eyes that show partial response, treatment may be continued, although re-evaluation with further imaging may be required to exclude confounding factors. Where there is persistent, unchanging accumulated fluid following three consecutive injections at monthly intervals, treatment may be withheld temporarily, but recommenced with the same or alternative anti-VEGF if the fluid subsequently increases (lesion considered active). Poor or non-response to anti-VEGF treatments requires re-evaluation of diagnosis and if necessary switch to alternative therapies including other anti-VEGF agents and/or with photodynamic therapy (PDT). Idiopathic polypoidal choroidopathy may require treatment with PDT monotherapy or combination with anti-VEGF. A committee comprised of retinal specialists with experience of managing patients with n-AMD similar to that which developed the Royal College of Ophthalmologists Guidelines to Ranibizumab was assembled. Individual aspects of the guidelines were proposed by the committee lead (WMA) based on relevant reference to published evidence base following a search of Medline and circulated to all committee members for discussion before approval or modification. Each draft was modified according to feedback from committee members until unanimous approval was obtained in the final draft. A system for categorising the range of responsiveness of n-AMD lesions to anti-VEGF therapy is proposed. The proposal is based primarily on morphological criteria but functional criteria have been included. Recommendations have been made on when to consider discontinuation of therapy either because of success or futility. These guidelines should help clinical decision-making and may prevent over and/or undertreatment with anti-VEGF therapy.
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Affiliation(s)
- W M Amoaku
- Division of Clinical Neurosciences, Department of Ophthalmology, Academic Ophthalmology, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, and the Royal Victoria Hospitals Trust, Belfast, UK
| | - R Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - M Gavin
- Department of Ophthalmology, Gartnavel Hospital, NHSGG, Glasgow, UK
| | - F Ghanchi
- Department of Ophthalmology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - J Gibson
- Department of Ophthalmology, School of Life and Health Sciences, Aston University and Heart of England NHS Foundation Trust, and Birmingham and Midland Eye Centre Birmingham, Birmingham, UK
| | - S Harding
- Department of Ophthalmology, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK
| | - R L Johnston
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - S Kelly
- Department of Ophthalmology, Royal Bolton Hospital, Bolton, UK
| | - A Lotery
- Department of Ophthalmology, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S Mahmood
- Department of Ophthalmology, Manchester Royal Eye Hospital, Central Manchester Hospitals Foundation Trust, Manchester, UK
| | - G Menon
- Department of Ophthalmology, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
| | - S Sivaprasad
- Department of Ophthalmology, NIHR Moorfields Biomedical Research Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - J Talks
- Department of Ophthalmology, Newcastle University Hospirtals NHS Trust, Newcastle, UK
| | - A Tufail
- Department of Ophthalmology, Moorfields Hospital NHS Trust, London, UK
| | - Y Yang
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
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Ennis S, Gibson J, Griffiths H, Bunyan D, Cree AJ, Robinson D, Self J, MacLeod A, Lotery A. Prevalence of myocilin gene mutations in a novel UK cohort of POAG patients. Eye (Lond) 2009; 24:328-33. [DOI: 10.1038/eye.2009.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Self J, Mercer C, Boon EMJ, Murugavel M, Shawkat F, Hammans S, Hodgkins P, Griffiths H, Lotery A. Infantile nystagmus and late onset ataxia associated with a CACNA1A mutation in the intracellular loop between s4 and s5 of domain 3. Eye (Lond) 2009; 23:2251-5. [DOI: 10.1038/eye.2008.389] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Rennie I, Singh AD, Lotery A. Publishing in Eye: The current status. Eye (Lond) 2006. [DOI: 10.1038/sj.eye.6702635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Joseph A, Rogers S, Browning A, Hall N, Barber C, Lotery A, Foley E, Amoaku WM. Syphilitic acute posterior placoid chorioretinitis in nonimmuno-compromised patients. Eye (Lond) 2006; 21:1114-9. [PMID: 17024225 DOI: 10.1038/sj.eye.6702504] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the clinical and angiographic features of three cases of secondary syphilis in immunocompetent patients, which presented as acute posterior placoid chorioretinitis (APPC) to the ophthalmologist. METHODS Interventional case series. The aetiology of the APPC was confirmed by serology to be secondary syphilis. Optical coherence tomography, electrophysiology, fundus fluorescein, and indocyanine green (ICG) angiography were performed at presentation and after resolution. Appropriate treatment for secondary syphilis was instituted in each patient. RESULTS The clinical features, fundus fluorescein and ICG angiography, multifocal electroretinography (mfERG), and optical coherence tomography findings of APPC are described. All three patients had a satisfactory resolution of the APPC with improvement in visual acuity. CONCLUSIONS APPC in secondary syphilis can occur even in immunocompetent patients. A high index of suspicion is required for early diagnosis of this condition resulting in a good visual outcome with adequate treatment. mfERG and optical coherence tomography are useful in the diagnosis and follow-up of these patients.
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Affiliation(s)
- A Joseph
- Department of Ophthalmology, Division of Ophthalmology and Visual Sciences, B Floor, Eye ENT Centre, Queen's Medical Centre, Clifton Blvd, Derby Road, Nottingham NG7 2UH, UK
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Abstract
This review highlights the history of the development of treatments for choroidal neovascularization (wct AMD). It examines how drug therapies have evolved for the management of age-related macular degeneration (AMD) and the value of randomised clinical trials in determining efficacy. Finally it examines the emerging practice of utilising bevacizumab for the treatment of choroidal neovascularization despite the lack of any phase III clinical trial data.
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Affiliation(s)
- C Canning
- Southampton Eye Unit, Southampton General Hospital, Southampton, UK
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Oh KT, Weleber RG, Lotery A, Oh DM, Billingslea AM, Stone EM. Description of a new mutation in rhodopsin, Pro23Ala, and comparison with electroretinographic and clinical characteristics of the Pro23His mutation. Arch Ophthalmol 2000; 118:1269-76. [PMID: 10980774 DOI: 10.1001/archopht.118.9.1269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To report the clinical characteristics of a family with autosomal dominant retinitis pigmentosa caused by a proline-to-alanine mutation at codon 23 (Pro23Ala) of the rhodopsin gene and to compare this phenotype with that associated with the more common proline-to-histidine mutation at codon 23 (Pro23His). METHODS We examined 6 patients within a single pedigree. The electroretinograms (ERGs) of 35 patients with known Pro23His mutations and of 22 healthy individuals were reviewed. Scotopic dim flash-response amplitudes, maximum combined-response amplitudes, and photopic-response amplitudes from the ERGs of these patients were plotted against age. The ERG indices of 5 individuals in the Pro23Ala family were compared with those of the patients with Pro23His mutations and of healthy individuals. Multiple linear regression was performed to evaluate the effect of age and mutation type on amplitudes. Mutation detection was performed using single-strand conformation polymorphism analysis, followed by automated DNA sequencing. RESULTS Patients with the Pro23Ala mutation have a clinical phenotype characterized by onset of symptoms in the second to fourth decades of life, loss of superior visual field with relatively well-preserved inferior fields, and mild nyctalopia. Comparison with patients with the Pro23His mutation demonstrates statistically significant differences (P<.001) in responses to dim flash, maximum combined, and photopic responses between patients with these mutations after controlling for the effects of age. Patients with Pro23Ala mutations were less affected by ERG criteria than patients with Pro23His mutations. Patients with Pro23Ala mutations also differed significantly from healthy patients in all ERG indices examined (P<.001), after controlling for age. CONCLUSION We describe a rare mutation in codon 23 of rhodopsin causing autosomal dominant retinitis pigmentosa. The retinal dystrophy associated with the Pro23Ala mutation is characteristically mild in presentation and course, with greater preservation of ERG amplitudes than the more prevalent Pro23His mutation. Arch Ophthalmol. 2000;118:1269-1276
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Affiliation(s)
- K T Oh
- Department of Opthamology and Visual Science, University of Iowa Hospitals and Clinics, Iowa City, USA
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Lotery A, Best J, Houston S. Occult giant cell (temporal) arteritis presenting with bilateral sixth and unilateral fourth nerve palsies. Eye (Lond) 1999; 12 ( Pt 6):1014-6. [PMID: 10326007 DOI: 10.1038/eye.1998.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Beatty S, Lotery A, Kent D, O'Driscoll A, Kilmartin DJ, Wallace D, Baglivo E. Acute intraoperative suprachoroidal haemorrhage in ocular surgery. Eye (Lond) 1999; 12 ( Pt 5):815-20. [PMID: 10070516 DOI: 10.1038/eye.1998.210] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE/BACKGROUND Acute intraoperative suprachoroidal haemorrhage (AISH) is the most sight-threatening complication of ocular surgery. We investigated the visual outcomes following this intraoperative event, patient characteristics that may predispose to it and the clinical features that may be of prognostic significance. METHODS The records of 45 cases of AISH collected from ophthalmic centres in the United Kingdom, Republic of Ireland and Switzerland were reviewed. Two satisfactory controls in terms of operative procedure, surgeon, age (+/- 5 years) and gender were found for each of 33 of our cases. Systemic and ocular characteristics were compared for cases and controls, and the visual results of all cases of AISH are analysed. RESULTS Cases and controls differed only in terms of axial length and pre-operative intraocular pressure, both of which were significantly greater for eyes that experienced an AISH (p < 0.05). Ten eyes (22.2%) achieved a final Snellen acuity of 6/12 or better. Statistically significant associations with a final acuity of counting fingers or worse included spontaneous nuclear expression (p = 0.02), retinal detachment (p < 0.0001), four-quadrant suprachoroidal haemorrhage (p = 0.007) and vision of perception of light or worse at the first dressing (p = 0.0001). Four of the 6 eyes that experienced an AISH during phacoemulsification surgery had a visual outcome of 6/12 or better, and this was significantly greater than for cases involving extracapsular cataract surgery (p = 0.004). CONCLUSION The results indicate that longer axial length and higher pre-operative intraocular pressure are associated with increased risk of AISH. Poor visual results are more likely following spontaneous nuclear expression, retinal detachment, four-quadrant suprachoroidal haemorrhage or vision of perception of light or worse at the first dressing. The results also suggest that AISH complicating a phacoemulsification procedure has a more favourable visual prognosis than AISH that occurs during extracapsular cataract surgery.
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Affiliation(s)
- S Beatty
- Birmingham and Midland Eye Centre, UK.
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Lotery A. Electronic mail can be protected from computer viruses. BMJ 1996; 312:1231. [PMID: 8634601 PMCID: PMC2350926 DOI: 10.1136/bmj.312.7040.1231c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Silvestri G, Lotery A, Collins A, Ennis K, Hughes A. 1141 Linkage studies in a large family with central areolar choroidal dystrophy. Vision Res 1995. [DOI: 10.1016/0042-6989(95)90037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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