Uveitis and Inflammatory Eye Disease
|Peter McCluskey||MBBS MD FRANZCO FRACS Director SSI & Unit Head|
|Denis Wakefield||MBBS MD DSc FRACP FRCPA Immunologist, UNSW and Sydney Eye Hospital|
|Nick di Girolamo ||BSc PhD Research Scientist, UNSW |
|Athena Roufas ||MBBS Eye Registrar and Research Fellow|
|Belinda Leong ||MBBS Eye Registrar and Research Fellow |
|John Chang ||MBBS PhD Eye Registrar and Research Fellow |
|Ed Hughes ||MBChB Retinal Fellow Sydney Eye Hospital |
The Uveitis and Inflammatory Eye Disease Research Group is a relatively new area of research at the Save Sight Institute. It was established in 2009 with the appointment of Professor Peter McCluskey as the Save Sight Institute’s Director.
A number of clinical studies have been undertaken using patients from the Save Sight Institute and Sydney Eye Hospital campus. At the same time, the research group has been progressing towards its longer term goal of establishing a DNA and patient database of patients with inflammatory eye disease.
Conjunctival Triamcinolone for Patients with Non-Necrotising Scleritis
This retrospective interventional case series determined the outcomes of 25 sub-conjunctival injections of Triamcinolone in 12 patients who had failed systemic therapy for non-necrotising anterior scleritis. Complete resolution of scleritis occurred in 23 out of the 25 treated eyes. There were no significant complications. Patients were followed up for a mean of nine months following intervention and 40% of treated eyes required repeat injections during the time of followup. This study provides evidence that sub-conjunctival Triamcinolone is an efficacious treatment with a prolonged duration of effect in patients with non-necrotising anterior scleritis who have failed to respond to their initial therapy.
10 Year Outcomes of Graft-Free Molteno Drainage Device Insertion
This study reported the 10 year followup data on 34 patients who had a molteno glaucoma drainage device inserted using a novel surgical technique that does not require an overlying donor scleral graft. At 10 years, the modified surgical technique was shown to be safe with no cases of molteno tube migration or exposure. At 10 year’s followup, 40% of the 34 treated patients, had a functioning successful glaucoma drainage device. This study shows that in long-term followup, the modified, simplified technique is not associated with additional complications, and provides equivalent intraocular pressure control to other surgical techniques. The main advantage of the modified technique is the elimination of the need for donor scleral grafting which eliminates the potential risk of Prion transmission.
Increased Frequency of Retinitis in Syphilitic Uveitis with HIV Co-Infection
This study reports the outcomes of 13 consecutive patients with syphilitic uveitis managed by members of the unit. There has been a resurgence of new infections with syphilis in our community over the past five years and this study presents 13 patients, 12 of whom were male and 6 of whom had co-infection with HIV infection. Men who have sex with men were the major risk group in this patient population. Patients developed characteristic retinitis and severe uveitis which responded rapidly and well to intensive antibiotic
and anti-inflammatory therapy. This study reinforces the importance of considering syphilis in the differential diagnosis of many different ocular presentations.
Tuberculous Uveitis in the Multicultural Australian Population
This study, which is still ongoing, seeks to determine the diagnostic criteria and management of patients with uveitis associated with TB. TB-related eye disease has become increasingly diagnosed in Australia despite the low prevalence of TB in our community. The majority of patients developing TB related eye disease in Australia have migrated from endemic high-prevalence TB areas. Thus far, we have data on 44 patients who have been diagnosed with TB-related uveitis and inflammatory eye disease.
We are continuing to accumulate patients and hope to have sufficient data to report this study in late 2010. At this time, it appears that TB-related uveitis and inflammatory eye disease is under-diagnosed in the Australian population. It appears that good visual outcomes and decreased rate of recurrence can be achieved with prompt diagnosis and treatment.