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Yates WB, McCluskey PJ, Fraser CL. Neuro-ophthalmological manifestations of sarcoidosis. J Neuroimmunol 2022; 367:577851. [DOI: 10.1016/j.jneuroim.2022.577851] [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] [Received: 12/10/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
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Shao EH, Yates WB, Ho IV, Chang AA, Simunovic MP. Endophthalmitis: Changes in Presentation, Management and the Role of Early Vitrectomy. Ophthalmol Ther 2021; 10:877-890. [PMID: 34694563 PMCID: PMC8589908 DOI: 10.1007/s40123-021-00406-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022] Open
Abstract
Endophthalmitis is a sight-threatening condition, and its timely and appropriate management is essential in preventing permanent vision loss. Recent changes in clinical practice in endophthalmitis and advances in modern vitreoretinal surgery may limit the applicability of established randomised clinical trial evidence to current management. This review discusses the epidemiology, pathophysiology, changing patient presentation, diagnosis and advances in the management of endophthalmitis, presenting the existing literature on this topic and results from Sydney Eye Hospital.
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Affiliation(s)
- Emily H Shao
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - William B Yates
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - I-Van Ho
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia
| | - Andrew A Chang
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia
| | - Matthew P Simunovic
- Retinal Unit, Sydney Eye Hospital, 8 Macquarie St., Sydney, NSW, 2000, Australia. .,Save Sight Institute, Sydney Eye Hospital, University of Sydney, South Block, Sydney, NSW, 2006, Australia.
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Dunn HP, Browning SD, Thomson D, Yates WB, McCluskey P, Keay L, White AJ, Fraser CL. Impact on patient management of non-mydriatic fundus photography compared to direct ophthalmoscopy in a regional Australian emergency department. Emerg Med Australas 2021; 34:186-193. [PMID: 34448357 DOI: 10.1111/1742-6723.13845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the management impact of non-mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. METHODS This before/after crossover study prospectively enrolled patients presenting with headache, neurological deficit, visual disturbance and/or hypertensive urgency. Patients received DO examination, then separate NMFP examination. Emergency clinicians (ECs) were surveyed on their patient management plans following both DO examination and NMFP imaging. Telemedicine review of NMFP images was performed by an ophthalmologist within 48 h, and any additional management changes were documented. RESULTS The use of NMFP influenced changes in management in 52 (39%) of 133 enrolled patients (95% confidence interval 31-48%). Of these, 65% were escalations of management due to acute fundus pathology, while 35% were de-escalating changes following normal fundus findings. ECs diagnostic accuracy for acute fundus pathology improved from 0% to 29% sensitivity, and 59% to 84% specificity using DO and NMFP respectively, and telemedicine registrar review increased this to 50% sensitivity and 86% specificity. The period prevalence of acute fundus pathology was 10.5% (95% confidence interval 6-17%). CONCLUSION The addition of NMFP images can significantly impact the management of ED patients requiring fundus examination, facilitating expedited and optimised patient care. NMFP improves ECs diagnostic acumen for fundus pathology over DO examination and telehealth specialist review is important for diagnostic accuracy. There is a clinically important prevalence of fundus pathology in this regional ED setting.
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Affiliation(s)
- Hamish P Dunn
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Samuel D Browning
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - David Thomson
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia
| | - William B Yates
- Faculty of Medicine, The University of New South Wales, Port Macquarie, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter McCluskey
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew J White
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Clare L Fraser
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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Yates WB, Keedwell EC. Offline Learning with a Selection Hyper-Heuristic: An Application to Water Distribution Network Optimisation. Evol Comput 2021; 29:187-210. [PMID: 32567958 DOI: 10.1162/evco_a_00277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
A sequence-based selection hyper-heuristic with online learning is used to optimise 12 water distribution networks of varying sizes. The hyper-heuristic results are compared with those produced by five multiobjective evolutionary algorithms. The comparison demonstrates that the hyper-heuristic is a computationally efficient alternative to a multiobjective evolutionary algorithm. An offline learning algorithm is used to enhance the optimisation performance of the hyper-heuristic. The optimisation results of the offline trained hyper-heuristic are analysed statistically, and a new offline learning methodology is proposed. The new methodology is evaluated, and shown to produce an improvement in performance on each of the 12 networks. Finally, it is demonstrated that offline learning can be usefully transferred from small, computationally inexpensive problems, to larger computationally expensive ones, and that the improvement in optimisation performance is statistically significant, with 99% confidence.
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Affiliation(s)
- William B Yates
- Computer Science, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK
| | - Edward C Keedwell
- Computer Science, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, EX4 4QF, UK
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Yates WB, Mammo Z, Simunovic MP. Intravitreal anti-vascular endothelial growth factor versus panretinal LASER photocoagulation for proliferative diabetic retinopathy: a systematic review and meta-analysis. Can J Ophthalmol 2021; 56:355-363. [PMID: 33631120 DOI: 10.1016/j.jcjo.2021.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically review and perform a meta-analysis on the available evidence for anti-vascular endothelial growth factor (anti-VEGF) monotherapy versus panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). DESIGN Systematic review and meta-analysis PARTICIPANTS: Randomized clinical trials included participants ≥18 years old with clinical or angiographic evidence of PDR. Interventions included were anti-VEGF monotherapy and PRP. Excluded studies were those with potentially biased treatment allocation and those offering combination therapies. METHODS The primary outcome was mean change in best-corrected visual acuity. Secondary outcomes were the proportion of patients developing severe (<6/60) or moderate (6/24-6/60) vision loss, rates of vitrectomy or vitreous hemorrhage, worsening macula edema, and reduced visual field indices. RESULTS Five studies of varying quality met the inclusion criteria (n = 632). The anti-VEGF intervention arm had a mean difference of -0.08 logMAR or 4 Early Treatment Diabetic Retinopathy Study (EDTRS) letters gained (p = 0.02) when compared with PRP at 12 months. The difference in rates of vitrectomy and vitreous hemorrhage favoured anti-VEGF over PRP (risk difference [RD] -0.10, p = < 0.001 and RD -0.10, p = 0.003 respectively). CONCLUSIONS This meta-analysis of the available evidence in patients with early PDR demonstrates a potential benefit for anti-VEGF over PRP alone. However, these benefits must be weighed against the relative costs of treatment and the potential risks of loss to follow-up.
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Affiliation(s)
- William B Yates
- Save Sight Institute, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia.
| | - Zaid Mammo
- Save Sight Institute, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia; Vancouver General Hospital/Eye Care Centre, Vancouver, BC
| | - Matthew P Simunovic
- Save Sight Institute, The University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia; Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
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Yates WB, Chiong F, Zagora S, Post JJ, Wakefield D, McCluskey P. Ocular Toxoplasmosis in a Tertiary Referral Center in Sydney Australia-Clinical Features, Treatment, and Prognosis. Asia Pac J Ophthalmol (Phila) 2019; 8:280-284. [PMID: 31369405 PMCID: PMC6727929 DOI: 10.1097/apo.0000000000000244] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/04/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to provide a retrospective analysis of the presentation, demographics, and treatment regimens for ocular toxoplasmosis at a large tertiary referral uveitis center. DESIGN Retrospective cohort study. PARTICIPANTS A total of 48 patients with ocular toxoplasmosis who presented to Sydney Eye Hospital participated in this study. METHODS This is a retrospective review of patient files who presented to Sydney Eye Hospital between 2007 and 2016 with clinical features consistent with ocular toxoplasmosis. Baseline risk factors and treatment details were recorded and analyzed. Main outcome measures were visual acuity and relapse rate compared with other studies in ocular toxoplasmosis. RESULTS The median age was 35.5 (interquartile range 21-50) with 30 (60%) patients having no previous symptomatic episodes or evidence of chorioretinal scarring. Visual acuity at presentation was 0.51 or 6/19 (SE 0.096) and at follow-up 0.31 or 6/12 (SE 0.094). Nine patients experienced a recurrence during the period of observation with median time to recurrence 2.2 years (SE 0.45) and the relapse rate was 0.09/person-years. Location of lesion was predominantly within the vascular arcades (n = 44) with macular involvement in 9 patients. Most patients received clindamycin therapy (n = 34) with pyrimethamine and sulfadiazine was used for those with macula involvement. CONCLUSIONS Patients with ocular toxoplasmosis had fewer recurrences compared with other published series and had better visual recovery. The majority of patients received clindamycin and oral prednisolone which were well tolerated with pyrimethazine and sulfadiazine reserved for those with macula-involving disease.
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MESH Headings
- Administration, Oral
- Adult
- Anti-Infective Agents/administration & dosage
- Antibodies, Protozoan/analysis
- Australia/epidemiology
- DNA, Protozoan/analysis
- Drug Therapy, Combination
- Eye Infections, Parasitic/diagnosis
- Eye Infections, Parasitic/drug therapy
- Eye Infections, Parasitic/epidemiology
- Female
- Fluorescein Angiography/methods
- Follow-Up Studies
- Fundus Oculi
- Glucocorticoids/administration & dosage
- Humans
- Incidence
- Male
- Middle Aged
- Polymerase Chain Reaction
- Prognosis
- Retrospective Studies
- Tertiary Care Centers
- Tomography, Optical Coherence/methods
- Toxoplasma/genetics
- Toxoplasma/immunology
- Toxoplasma/isolation & purification
- Toxoplasmosis, Ocular/diagnosis
- Toxoplasmosis, Ocular/drug therapy
- Toxoplasmosis, Ocular/epidemiology
- Visual Acuity
- Young Adult
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Affiliation(s)
- William B. Yates
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Fabian Chiong
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Sophia Zagora
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Jeffrey J. Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Denis Wakefield
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- NSW Health Pathology, NSW Health, New South Wales, Australia
| | - Peter McCluskey
- The University of Sydney, Save Sight Institute, Sydney, Australia
- Sydney Eye Hospital, Sydney, Australia
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Lee JTL, Yates WB, Rogers S, Wakefield D, McCluskey P, Lim LL. Adalimumab for the treatment of refractory active and inactive non-infectious uveitis. Br J Ophthalmol 2018; 102:1672-1678. [DOI: 10.1136/bjophthalmol-2017-311234] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 11/04/2022]
Abstract
Background/aimsTo compare the efficacy of adalimumab in eyes with active and inactive non-infectious uveitis in the real-world setting.MethodsMulticentre, retrospective, chart review of patients with refractory non-infectious uveitis treated with adalimumab. Main outcome measures included reduction of prednisolone dose, ability to taper immunosuppressives and a composite endpoint of treatment failure encompassing active inflammatory chorioretinal or retinal vascular lesions, intraocular inflammation grade and visual acuity.ResultsThirty-seven eyes of 22 patients were studied. Mean follow-up was 20.1 months (median: 13). Most had either posterior or panuveitis (n=12, 55%). Mean duration of uveitis at baseline was 83.2 months (median: 61), where the majority (n=15, 68%) had already been treated with two or more conventional immunosuppressive agents in addition to prednisolone. Oral prednisolone was reduced to ≤10 mg/day in 9 of 12 patients (75%) by 6 weeks. At 6 months of therapy, nine (90%) of the active eyes achieved a 2-step improvement in anterior chamber inflammation, with six (60%) demonstrating a similar improvement in vitreous haze grade. Almost all (n=17, 94%) of the initially inactive eyes maintained clinical quiescence at this time point. The incidence rate of treatment failure during follow-up was 88 per 100 eye-years for the active eyes and 24 per 100 eye-years for the initially inactive eyes. There were no serious adverse effects.ConclusionAdalimumab appears to reduce the corticosteroid burden in active and inactive non-infectious uveitis in the real-world setting. Inflammatory activity at the time of adalimumab commencement may determine long-term treatment success.
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Yates WB, Vajdic CM, Na R, McCluskey PJ, Wakefield D. Malignancy Risk in Patients with Inflammatory Eye Disease Treated with Systemic Immunosuppressive Therapy. Ophthalmology 2015; 122:265-73. [DOI: 10.1016/j.ophtha.2014.08.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/30/2014] [Accepted: 08/12/2014] [Indexed: 10/24/2022] Open
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Yates WB, McCluskey PJ, Wakefield D. Are patients with inflammatory eye disease treated with systemic immunosuppressive therapy at increased risk of malignancy? J Ophthalmic Inflamm Infect 2013; 3:48. [PMID: 23724805 PMCID: PMC3695808 DOI: 10.1186/1869-5760-3-48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 05/15/2013] [Indexed: 12/23/2022] Open
Abstract
The purpose of this study is to review the literature on the risk of malignancy in patients with inflammatory eye disease (IED) treated with systemic immunosuppressive (IS) therapy. Relevant databases in transplant medicine, autoimmune diseases and literature regarding uveitis and scleritis were reviewed. Literature with regards systemic IS therapy in transplant recipients and patients with autoimmune diseases revealed a significant increase in malignancies, especially non-melanocytic skin cancers and lymphomas. Studies of patients with IED were limited in number and scope, with no studies adequately evaluating the incidence of malignancy in these patients. Difficulties associated with the evaluation of the risk of malignancy associated with IS therapy in patients with IED include the heterogeneity of the disease and treatment regimens as well as the low frequency of IED, its variable severity and the lack of adequate long-term follow-up studies. Systemic IS therapy is an important therapeutic option in the treatment of patients with severe IED. A well-designed, comprehensive, multi-centre long-term follow-up study is required to evaluate the risk of malignancy in patients with specific IED diseases treated with defined systemic IS therapy. Until such evidence is available, we recommend the adoption of preventative strategies to help minimise the risk of malignancy in such patients.
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Affiliation(s)
- William B Yates
- Inflammation Research Unit, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia.
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Abstract
In this paper we address the problem of constructing reliable neural-net implementations, given the assumption that any particular implementation will not be totally correct. The approach taken in this paper is to organize the inevitable errors so as to minimize their impact in the context of a multiversion system, i.e., the system functionality is reproduced in multiple versions, which together will constitute the neural-net system. The unique characteristics of neural computing are exploited in order to engineer reliable systems in the form of diverse, multiversion systems that are used together with a "decision strategy" (such as majority vote). Theoretical notions of "methodological diversity" contributing to the improvement of system performance are implemented and tested. An important aspect of the engineering of an optimal system is to overproduce the components and then choose an optimal subset. Three general techniques for choosing final system components are implemented and evaluated. Several different approaches to the effective engineering of complex multiversion systems designs are realized and evaluated to determine overall reliability as well as reliability of the overall system in comparison to the lesser reliability of component substructures.
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Affiliation(s)
- D Partridge
- Department of Computer Science, University of Exeter, England
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