Laurence Sullivan - Academia.edu (original) (raw)

Papers by Laurence Sullivan

PubMed, Dec 1, 1991

Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients ... more Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients with histologically verified pituitary adenoma and visual defects (fields and/or acuity) were reviewed. The patients' ages ranged from 19 to 80 years with a mean of 52.4 years. Ophthalmologists referred 76% of the patients for neurosurgical opinion. Bitemporal field defects were present in 89%. Twenty-three patients underwent transfrontal craniotomy prior to 1984, and the remaining twenty-two subsequently had transsphenoidal microsurgery. Of those eyes with abnormal visual acuity preoperatively, 74% had improvement noted postoperatively (p less than 0.001). Of those eyes with preoperatively abnormal visual fields, 68% improved (p less than 0.001). For transsphenoidal surgery the rate of improvement for fields was 81%. Preoperative visual acuity, visual field score, and patient age, were not predictive of postoperative acuity. Optic disc pallor was associated with poorer postoperative fields and acuity compared to eyes without preoperative pallor. Transsphenoidal surgery is effective treatment for visual compromise due to pituitary adenoma, and the need for early diagnosis is emphasized.

CRC Press eBooks, Aug 12, 2005

... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LAS... more ... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LASIK Ancillary Instruments and Operating Environment Variables Rakesh Ahuja, Jeewan S Titiyal ... Refractive Surgery and Strabismus Lionel M Kowal, Ravindra R Battu 136 14. ...

Journal of Cataract and Refractive Surgery, Dec 1, 2006

To compare the change in residual stromal thickness and flap thickness between primary laser in s... more To compare the change in residual stromal thickness and flap thickness between primary laser in situ keratomileusis (LASIK) and repeat LASIK in myopic patients. Melbourne Excimer Laser Group, East Melbourne, Australia. This retrospective nonrandomized comparative trial comprised 46 eyes of 34 patients who had repeat LASIK. The thickness of the residual stromal bed was calculated by subtracting the calculated stromal ablation from pachymetry of the stromal bed after cutting the flap in primary treatment and directly measuring during retreatment. The thickness of the LASIK flap in primary and repeat LASIK was calculated by subtracting the central pachymetry of the stromal bed after creating the flap from pachymetry before cutting and lifting the flap, respectively. The main outcome measures were comparison of the residual stromal bed and flap thickness between the primary treatment and the retreatment. The mean thickness of the calculated residual stromal bed after primary treatment was 329.8 microm +/- 40.8 (SD), and the mean measured residual stromal bed at retreatment was 317.3 +/- 42.8 microm. The mean difference in residual stromal bed thickness was 12.5 +/- 13.0 microm (P<.001). Sixteen eyes (34.7%) had a decrease in bed thickness between 11 microm and 20 microm. The mean flap thickness during primary LASIK and repeat LASIK was 145.2 +/- 17.1 microm and 169 +/- 18.3 microm, respectively. The mean interval between primary treatment and retreatment was 7.4 +/- 4.1 months. The mean change in flap thickness was 23.8 +/- 15.2 microm (P<.001). Fifteen eyes (32%) had an increase in flap thickness between 11 microm and 20 microm. There was a negative correlation between refractive error before primary treatment and the difference in flap thickness. No correlation was found between the difference in flap thickness and the interval between the primary treatment and the repeat treatment. Intraoperative pachymetry of the stromal bed during retreatment is strongly recommended as the residual stromal bed and flap thickness changes between primary and retreatment. There is a tendency for the measured stromal bed at retreatment to be thinner than the calculated stromal bed and for the flap to be thicker than previously measured.

Clinical and Experimental Optometry, Jul 1, 2001

A significant degree of corneal astigmatism can be induced by the encroachment of a pterygium ont... more A significant degree of corneal astigmatism can be induced by the encroachment of a pterygium onto a cornea. The pterygium generally causes with-the-rule corneal astigmatism that is hemimeridional on the side of the pterygium. There is a significant correlation between the extension of the pterygium onto the cornea and the amount of induced astigmatism. However, there is a poor correlation between pterygium-induced astigmatism measured topographically and that measured by manifest refraction. Successful pterygium surgery will reduce pterygium-induced refractive astigmatism and improve visual acuity. This paper outlines the management of a patient with an advanced pterygium, in whom a large degree of corneal astigmatism was induced by the encroachment of a pterygium onto the cornea. Subsequent excision of the pterygium brought about a reversal of the pterygium-induced corneal astigmatism.

Seminars in Ophthalmology, 1993

Current Opinion in Ophthalmology, Aug 1, 1996

Cornea, Nov 1, 2001

Purpose. To determine the efficacy and safety of topical autologous serum as a treatment of dry e... more Purpose. To determine the efficacy and safety of topical autologous serum as a treatment of dry eye patients. Methods. A 2-month, prospective, single-masked, placebo-controlled study was conducted in patients with bilateral severe dry eye. One eye was randomized to receive the patient's own serum as a tear substitute, and the fellow eye received unpreserved normal saline solution as a placebo. Subjective symptoms and clinical parameters of dry eye including conjunctival impression cytology were assessed at baseline and 1 week, 1 month, and 2 months after treatment. Results. Twelve dry eye patients were enrolled. Both subjective symptoms (discomfort, foreign-body sensation, dryness, and photophobia), objective signs (fluorescein and rose bengal staining and conjunctival impression cytology) improved significantly in treated eyes compared with baseline. Control eyes also had improvement in symptoms, signs, and rose bengal staining compared with baseline. Neither Schirmer test results nor tear break-up time improved in either group. The means score of all parameters were improved in both groups, and the results of conjunctival impression cytology were better in treated eyes; however, these results are not significantly different. There were no serious adverse effects observed in this study. Conclusions. There was a trend toward improvement in symptoms and signs of dry eye including cytologic changes after application of autologous serum in severe dry eye patients. However, this trend was not statistically significant. A larger scale study is warranted.

Australian and New Zealand Journal of Ophthalmology, Aug 1, 1994

Background : The fungus Scedosporium prolificans was first described as a human pathogen in 1984,... more Background : The fungus Scedosporium prolificans was first described as a human pathogen in 1984, and has been associated with metastatic endophthalmitis and one previously reported case of sclerokeratitis. Methods : We report a case of S. prolificans sclerokeratitis in the setting of late scleral necrosis complicating pterygium surgery with adjunctive (3‐irradiation. Results : A poor clinical response to topical natamycin and amphotericin B, and systemic itraconazole and ketoconazole was encountered. Enucleation was required, with subsequent microbiological cure. Pathological correlation is described. Conclusions : S. prolificans infections often respond poorly to medical therapy. Early surgical intervention is indicated in culture‐proven scleritis due to Scedosporium prolificans.

British Journal of Ophthalmology, Aug 1, 2001

Aim-To study the eYcacy of phototherapeutic keratectomy (PTK) for pain relief for patients with p... more Aim-To study the eYcacy of phototherapeutic keratectomy (PTK) for pain relief for patients with painful bullous keratopathy and poor visual potential. Methods-Patients with painful bullous keratopathy and poor visual potential were treated with superficial PTK (8-25 µm), intermediate (50-100 µm) or deep PTK (25% stromal thickness) using the Nidek EC5000 excimer laser after manual epithelial debridement. Follow up ranged from 1 to 24 months (mean 6.5 months). Outcome measures included symptomatic relief and need for further treatment. Results-In the superficial PTK group five of eight (62%) patients improved symptomatically after treatment. The three (38%) who did not improve went on to have penetrating keratoplasty for pain relief. In the intermediate depth group only two of five (40%) patients had symptom alleviation. The three others (60%) required further procedures. 20 of 24 (83%) patients treated with deep PTK had significant or total alleviation of symptoms. Of these, one developed acute anterior uveitis 9 months after PTK and two required botulinum ptosis for persistent corneal epithelial defects, one of whom had three consecutive episodes of microbial keratitis. Three of 24 suVered occasional discomfort and one patient required a penetrating keratoplasty for continued pain. Conclusion-PTK can be a useful therapeutic measure in painful bullous keratopathy with poor visual potential. Deep PTK appears to be more successful in pain management than superficial treatment.

PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen... more PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen cross-linking (ACXL) for the treatment of keratoconus. METHODS. PubMed, Embase, the Cochrane Library, and the US trial registry were searched for trials comparing SCXL and ACXL for keratoconus up to October 2017. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Primary outcomes were changes in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness (CCT), and endothelial cell density (ECD). RESULTS. Eleven trials were included. For primary outcomes, SCXL showed a greater reduction in Kmax (SMD 0.32; 95% CI 0.16, 0.48) than ACXL. For secondary outcomes, the decrease in CCT (SMD 0.32; 95% CI 0.03, 0.61) and ECD (SMD 0.26; 95% CI 0.06, 0.46) was less with ACXL than with SCXL. For the other outcomes, there were no statistically significant differences. CONCLUSIONS. SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.

Archives of Ophthalmology, Nov 1, 1993

To ascertain and characterize rhodopsin gene mutations in autosomal dominant retinitis pigmentosa... more To ascertain and characterize rhodopsin gene mutations in autosomal dominant retinitis pigmentosa and to correlate these mutations with the clinical phenotypes. DNA was extracted from leukocytes, and the rhodopsin gene was amplified and analyzed using molecular-biological methods. Clinical and electrophysiological data were collected from patient charts. We found a disease-causing mutation that was previously undescribed, to our knowledge, for autosomal dominant retinitis pigmentosa within codon 15 of exon 1 of the rhodopsin gene. It was a single base-pair transversion (AAT to AGT) leading to a serine-for-asparagine substitution. This altered a glycosylation site in the intradiscal portion of the rhodopsin molecule. The pedigree examined demonstrated an inferior distribution of retinal pigmentary changes and predominantly superior visual field loss with relative preservation of electroretinographic amplitudes and good vision, which is consistent with sectorial or sectorial-like retinitis pigmentosa. A codon 15 rhodopsin gene mutation caused retinitis pigmentosa in the pedigree studied. There may be an association between intradiscal rhodopsin gene mutations and sectorial forms of retinitis pigmentosa.

Australian and New Zealand Journal of Ophthalmology, Aug 1, 1994

Objective : To report six cases of sterile inflammatory reactions to fine monofilament suture mat... more Objective : To report six cases of sterile inflammatory reactions to fine monofilament suture materials, which is exceedingly rare in ophthalmology. Methods : We report six patients (four underwent penetrating keratoplasty and two underwent cataract surgery) with unusually severe local inflammatory reactions to suture material. Results : Patients developed multiple focal inflammatory infiltrates and corneal oedema related to 10/0 monofilament nylon sutures. Four patients had evidence of either atopy or raised serum IgE and one had an autoimmune disorder (systemic lupus erythematosis). Onset was four to 11 days in five cases and six weeks in one. Allograft reaction occurred in two of the four corneal grafts, and three grafts failed. One of the cataract patients developed significant against‐the‐rule astigmatism. Microbial cultures of corneal scrapings, donor corneal rims, and suture material were generally negative. Polymorphonuclear leucocytes were noted on Gram stain in four cases, and cytology of corneal scrapings demonstrated eosinophils in one case. Conclusions : Sterile inflammatory reactions to monofilament suture material are an uncommon complication of ocular surgery which may lead to corneal graft failure, and which is more common in atopic individuals. Systemic steroid therapy may be required.

Clinical & Experimental Ophthalmology, 2021

Synopsis: Treatment of specific cancers was revolutionised through the use of immune checkpoint b... more Synopsis: Treatment of specific cancers was revolutionised through the use of immune checkpoint blockade (ICI) which unleashes the body's own immune surveillance and mechanisms to kill tumour cells. This innovative treatment strategy induces remission for many patients with treatment-resistant cancers. Unintended consequences of ICI result from disrupting tolerance, therefore creating autoimmune consequences which can affect the eye and central nervous system. Following ICI therapy, case reports and series document dry eye, uveitis and multiple neuro-ophthalmic complications involving the optic nerve, cranial nerves, neuromuscular junction and extraocular muscles. The majority of patients with uveitis or optic nerve disease respond to discontinuing the ICI or to systemic or local corticosteroid therapy. Clinical improvement is however variable for patients with other types of neuro-ophthalmic sequelae. Case series provide insights about specific disease sequelae but do not help us understand the incidence or prevalence of complications following ICI therapy. Two big data studies provide additional complementary information, one using the IRIS database developed by the American Academy of Ophthalmology, and the other using the Kaiser Permanent Medical Record system. Using big data, cancer patients were identified to have a higher rate of uveitis and neuro-ophthalmic disease, even without the use of ICI. Patients with a prior history of immune-mediated ocular disease, uveitis or other, had a higher rate of recurrent disease following ICI therapy. Coordination of care between ophthalmologists and oncologists is suggested for patients in which ICI therapy is indicated.

... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LAS... more ... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LASIK Ancillary Instruments and Operating Environment Variables Rakesh Ahuja, Jeewan S Titiyal ... Refractive Surgery and Strabismus Lionel M Kowal, Ravindra R Battu 136 14. ...

Investigative Opthalmology & Visual Science, 2018

PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen... more PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen cross-linking (ACXL) for the treatment of keratoconus. METHODS. PubMed, Embase, the Cochrane Library, and the US trial registry were searched for trials comparing SCXL and ACXL for keratoconus up to October 2017. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Primary outcomes were changes in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness (CCT), and endothelial cell density (ECD). RESULTS. Eleven trials were included. For primary outcomes, SCXL showed a greater reduction in Kmax (SMD 0.32; 95% CI 0.16, 0.48) than ACXL. For secondary outcomes, the decrease in CCT (SMD 0.32; 95% CI 0.03, 0.61) and ECD (SMD 0.26; 95% CI 0.06, 0.46) was less with ACXL than with SCXL. For the other outcomes, there were no statistically significant differences. CONCLUSIONS. SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.

PubMed, Dec 1, 1991

Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients ... more Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients with histologically verified pituitary adenoma and visual defects (fields and/or acuity) were reviewed. The patients' ages ranged from 19 to 80 years with a mean of 52.4 years. Ophthalmologists referred 76% of the patients for neurosurgical opinion. Bitemporal field defects were present in 89%. Twenty-three patients underwent transfrontal craniotomy prior to 1984, and the remaining twenty-two subsequently had transsphenoidal microsurgery. Of those eyes with abnormal visual acuity preoperatively, 74% had improvement noted postoperatively (p less than 0.001). Of those eyes with preoperatively abnormal visual fields, 68% improved (p less than 0.001). For transsphenoidal surgery the rate of improvement for fields was 81%. Preoperative visual acuity, visual field score, and patient age, were not predictive of postoperative acuity. Optic disc pallor was associated with poorer postoperative fields and acuity compared to eyes without preoperative pallor. Transsphenoidal surgery is effective treatment for visual compromise due to pituitary adenoma, and the need for early diagnosis is emphasized.

CRC Press eBooks, Aug 12, 2005

... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LAS... more ... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LASIK Ancillary Instruments and Operating Environment Variables Rakesh Ahuja, Jeewan S Titiyal ... Refractive Surgery and Strabismus Lionel M Kowal, Ravindra R Battu 136 14. ...

Journal of Cataract and Refractive Surgery, Dec 1, 2006

To compare the change in residual stromal thickness and flap thickness between primary laser in s... more To compare the change in residual stromal thickness and flap thickness between primary laser in situ keratomileusis (LASIK) and repeat LASIK in myopic patients. Melbourne Excimer Laser Group, East Melbourne, Australia. This retrospective nonrandomized comparative trial comprised 46 eyes of 34 patients who had repeat LASIK. The thickness of the residual stromal bed was calculated by subtracting the calculated stromal ablation from pachymetry of the stromal bed after cutting the flap in primary treatment and directly measuring during retreatment. The thickness of the LASIK flap in primary and repeat LASIK was calculated by subtracting the central pachymetry of the stromal bed after creating the flap from pachymetry before cutting and lifting the flap, respectively. The main outcome measures were comparison of the residual stromal bed and flap thickness between the primary treatment and the retreatment. The mean thickness of the calculated residual stromal bed after primary treatment was 329.8 microm +/- 40.8 (SD), and the mean measured residual stromal bed at retreatment was 317.3 +/- 42.8 microm. The mean difference in residual stromal bed thickness was 12.5 +/- 13.0 microm (P<.001). Sixteen eyes (34.7%) had a decrease in bed thickness between 11 microm and 20 microm. The mean flap thickness during primary LASIK and repeat LASIK was 145.2 +/- 17.1 microm and 169 +/- 18.3 microm, respectively. The mean interval between primary treatment and retreatment was 7.4 +/- 4.1 months. The mean change in flap thickness was 23.8 +/- 15.2 microm (P<.001). Fifteen eyes (32%) had an increase in flap thickness between 11 microm and 20 microm. There was a negative correlation between refractive error before primary treatment and the difference in flap thickness. No correlation was found between the difference in flap thickness and the interval between the primary treatment and the repeat treatment. Intraoperative pachymetry of the stromal bed during retreatment is strongly recommended as the residual stromal bed and flap thickness changes between primary and retreatment. There is a tendency for the measured stromal bed at retreatment to be thinner than the calculated stromal bed and for the flap to be thicker than previously measured.

Clinical and Experimental Optometry, Jul 1, 2001

A significant degree of corneal astigmatism can be induced by the encroachment of a pterygium ont... more A significant degree of corneal astigmatism can be induced by the encroachment of a pterygium onto a cornea. The pterygium generally causes with-the-rule corneal astigmatism that is hemimeridional on the side of the pterygium. There is a significant correlation between the extension of the pterygium onto the cornea and the amount of induced astigmatism. However, there is a poor correlation between pterygium-induced astigmatism measured topographically and that measured by manifest refraction. Successful pterygium surgery will reduce pterygium-induced refractive astigmatism and improve visual acuity. This paper outlines the management of a patient with an advanced pterygium, in whom a large degree of corneal astigmatism was induced by the encroachment of a pterygium onto the cornea. Subsequent excision of the pterygium brought about a reversal of the pterygium-induced corneal astigmatism.

Seminars in Ophthalmology, 1993

Current Opinion in Ophthalmology, Aug 1, 1996

Cornea, Nov 1, 2001

Purpose. To determine the efficacy and safety of topical autologous serum as a treatment of dry e... more Purpose. To determine the efficacy and safety of topical autologous serum as a treatment of dry eye patients. Methods. A 2-month, prospective, single-masked, placebo-controlled study was conducted in patients with bilateral severe dry eye. One eye was randomized to receive the patient's own serum as a tear substitute, and the fellow eye received unpreserved normal saline solution as a placebo. Subjective symptoms and clinical parameters of dry eye including conjunctival impression cytology were assessed at baseline and 1 week, 1 month, and 2 months after treatment. Results. Twelve dry eye patients were enrolled. Both subjective symptoms (discomfort, foreign-body sensation, dryness, and photophobia), objective signs (fluorescein and rose bengal staining and conjunctival impression cytology) improved significantly in treated eyes compared with baseline. Control eyes also had improvement in symptoms, signs, and rose bengal staining compared with baseline. Neither Schirmer test results nor tear break-up time improved in either group. The means score of all parameters were improved in both groups, and the results of conjunctival impression cytology were better in treated eyes; however, these results are not significantly different. There were no serious adverse effects observed in this study. Conclusions. There was a trend toward improvement in symptoms and signs of dry eye including cytologic changes after application of autologous serum in severe dry eye patients. However, this trend was not statistically significant. A larger scale study is warranted.

Australian and New Zealand Journal of Ophthalmology, Aug 1, 1994

Background : The fungus Scedosporium prolificans was first described as a human pathogen in 1984,... more Background : The fungus Scedosporium prolificans was first described as a human pathogen in 1984, and has been associated with metastatic endophthalmitis and one previously reported case of sclerokeratitis. Methods : We report a case of S. prolificans sclerokeratitis in the setting of late scleral necrosis complicating pterygium surgery with adjunctive (3‐irradiation. Results : A poor clinical response to topical natamycin and amphotericin B, and systemic itraconazole and ketoconazole was encountered. Enucleation was required, with subsequent microbiological cure. Pathological correlation is described. Conclusions : S. prolificans infections often respond poorly to medical therapy. Early surgical intervention is indicated in culture‐proven scleritis due to Scedosporium prolificans.

British Journal of Ophthalmology, Aug 1, 2001

Aim-To study the eYcacy of phototherapeutic keratectomy (PTK) for pain relief for patients with p... more Aim-To study the eYcacy of phototherapeutic keratectomy (PTK) for pain relief for patients with painful bullous keratopathy and poor visual potential. Methods-Patients with painful bullous keratopathy and poor visual potential were treated with superficial PTK (8-25 µm), intermediate (50-100 µm) or deep PTK (25% stromal thickness) using the Nidek EC5000 excimer laser after manual epithelial debridement. Follow up ranged from 1 to 24 months (mean 6.5 months). Outcome measures included symptomatic relief and need for further treatment. Results-In the superficial PTK group five of eight (62%) patients improved symptomatically after treatment. The three (38%) who did not improve went on to have penetrating keratoplasty for pain relief. In the intermediate depth group only two of five (40%) patients had symptom alleviation. The three others (60%) required further procedures. 20 of 24 (83%) patients treated with deep PTK had significant or total alleviation of symptoms. Of these, one developed acute anterior uveitis 9 months after PTK and two required botulinum ptosis for persistent corneal epithelial defects, one of whom had three consecutive episodes of microbial keratitis. Three of 24 suVered occasional discomfort and one patient required a penetrating keratoplasty for continued pain. Conclusion-PTK can be a useful therapeutic measure in painful bullous keratopathy with poor visual potential. Deep PTK appears to be more successful in pain management than superficial treatment.

PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen... more PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen cross-linking (ACXL) for the treatment of keratoconus. METHODS. PubMed, Embase, the Cochrane Library, and the US trial registry were searched for trials comparing SCXL and ACXL for keratoconus up to October 2017. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Primary outcomes were changes in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness (CCT), and endothelial cell density (ECD). RESULTS. Eleven trials were included. For primary outcomes, SCXL showed a greater reduction in Kmax (SMD 0.32; 95% CI 0.16, 0.48) than ACXL. For secondary outcomes, the decrease in CCT (SMD 0.32; 95% CI 0.03, 0.61) and ECD (SMD 0.26; 95% CI 0.06, 0.46) was less with ACXL than with SCXL. For the other outcomes, there were no statistically significant differences. CONCLUSIONS. SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.

Archives of Ophthalmology, Nov 1, 1993

To ascertain and characterize rhodopsin gene mutations in autosomal dominant retinitis pigmentosa... more To ascertain and characterize rhodopsin gene mutations in autosomal dominant retinitis pigmentosa and to correlate these mutations with the clinical phenotypes. DNA was extracted from leukocytes, and the rhodopsin gene was amplified and analyzed using molecular-biological methods. Clinical and electrophysiological data were collected from patient charts. We found a disease-causing mutation that was previously undescribed, to our knowledge, for autosomal dominant retinitis pigmentosa within codon 15 of exon 1 of the rhodopsin gene. It was a single base-pair transversion (AAT to AGT) leading to a serine-for-asparagine substitution. This altered a glycosylation site in the intradiscal portion of the rhodopsin molecule. The pedigree examined demonstrated an inferior distribution of retinal pigmentary changes and predominantly superior visual field loss with relative preservation of electroretinographic amplitudes and good vision, which is consistent with sectorial or sectorial-like retinitis pigmentosa. A codon 15 rhodopsin gene mutation caused retinitis pigmentosa in the pedigree studied. There may be an association between intradiscal rhodopsin gene mutations and sectorial forms of retinitis pigmentosa.

Australian and New Zealand Journal of Ophthalmology, Aug 1, 1994

Objective : To report six cases of sterile inflammatory reactions to fine monofilament suture mat... more Objective : To report six cases of sterile inflammatory reactions to fine monofilament suture materials, which is exceedingly rare in ophthalmology. Methods : We report six patients (four underwent penetrating keratoplasty and two underwent cataract surgery) with unusually severe local inflammatory reactions to suture material. Results : Patients developed multiple focal inflammatory infiltrates and corneal oedema related to 10/0 monofilament nylon sutures. Four patients had evidence of either atopy or raised serum IgE and one had an autoimmune disorder (systemic lupus erythematosis). Onset was four to 11 days in five cases and six weeks in one. Allograft reaction occurred in two of the four corneal grafts, and three grafts failed. One of the cataract patients developed significant against‐the‐rule astigmatism. Microbial cultures of corneal scrapings, donor corneal rims, and suture material were generally negative. Polymorphonuclear leucocytes were noted on Gram stain in four cases, and cytology of corneal scrapings demonstrated eosinophils in one case. Conclusions : Sterile inflammatory reactions to monofilament suture material are an uncommon complication of ocular surgery which may lead to corneal graft failure, and which is more common in atopic individuals. Systemic steroid therapy may be required.

Clinical & Experimental Ophthalmology, 2021

Synopsis: Treatment of specific cancers was revolutionised through the use of immune checkpoint b... more Synopsis: Treatment of specific cancers was revolutionised through the use of immune checkpoint blockade (ICI) which unleashes the body's own immune surveillance and mechanisms to kill tumour cells. This innovative treatment strategy induces remission for many patients with treatment-resistant cancers. Unintended consequences of ICI result from disrupting tolerance, therefore creating autoimmune consequences which can affect the eye and central nervous system. Following ICI therapy, case reports and series document dry eye, uveitis and multiple neuro-ophthalmic complications involving the optic nerve, cranial nerves, neuromuscular junction and extraocular muscles. The majority of patients with uveitis or optic nerve disease respond to discontinuing the ICI or to systemic or local corticosteroid therapy. Clinical improvement is however variable for patients with other types of neuro-ophthalmic sequelae. Case series provide insights about specific disease sequelae but do not help us understand the incidence or prevalence of complications following ICI therapy. Two big data studies provide additional complementary information, one using the IRIS database developed by the American Academy of Ophthalmology, and the other using the Kaiser Permanent Medical Record system. Using big data, cancer patients were identified to have a higher rate of uveitis and neuro-ophthalmic disease, even without the use of ICI. Patients with a prior history of immune-mediated ocular disease, uveitis or other, had a higher rate of recurrent disease following ICI therapy. Coordination of care between ophthalmologists and oncologists is suggested for patients in which ICI therapy is indicated.

... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LAS... more ... Rakesh Ahuja, RasikB Vajpayee 36 6. Microkeratomes Rasik B Vajpayee, Namrata Sharma 54 7. LASIK Ancillary Instruments and Operating Environment Variables Rakesh Ahuja, Jeewan S Titiyal ... Refractive Surgery and Strabismus Lionel M Kowal, Ravindra R Battu 136 14. ...

Investigative Opthalmology & Visual Science, 2018

PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen... more PURPOSE. To systematically compare epithelial-off standard (SCXL) to accelerated corneal collagen cross-linking (ACXL) for the treatment of keratoconus. METHODS. PubMed, Embase, the Cochrane Library, and the US trial registry were searched for trials comparing SCXL and ACXL for keratoconus up to October 2017. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Primary outcomes were changes in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness (CCT), and endothelial cell density (ECD). RESULTS. Eleven trials were included. For primary outcomes, SCXL showed a greater reduction in Kmax (SMD 0.32; 95% CI 0.16, 0.48) than ACXL. For secondary outcomes, the decrease in CCT (SMD 0.32; 95% CI 0.03, 0.61) and ECD (SMD 0.26; 95% CI 0.06, 0.46) was less with ACXL than with SCXL. For the other outcomes, there were no statistically significant differences. CONCLUSIONS. SCXL has a greater effect in terms of reduction in Kmax than ACXL, while ACXL induces less reduction in CCT and ECD than SCXL. Further well-designed randomized controlled trials comparing ACXL and SCXL are indicated.