Alex Harper - Academia.edu (original) (raw)

Papers by Alex Harper

Archives of Ophthalmology, 2006

Ophthalmology, 2000

We describe an unusual ocular presentation of ocular-central nervous system lymphoma in a young p... more We describe an unusual ocular presentation of ocular-central nervous system lymphoma in a young patient. Interventional case report and literature review. A previously well 24-year-old white woman presented with left eye pain and reduced vision. Episcleral injection, globe tenderness, an afferent pupil defect, and exudative retinal detachment were present. Computed tomographic scan of the head and orbits demonstrated scleral thickening, retinal detachment, and no other abnormality. A provisional diagnosis of posterior scleritis with exudative retinal detachment was made. Investigation for underlying connective tissue diseases was negative. There was an initial prompt response to corticosteroid therapy. The patient's symptoms and signs then recurred, and a left third cranial nerve palsy developed. Systemic investigations including lumbar puncture ultimately led to the diagnosis of primary T-cell central nervous system (CNS) lymphoma. Serologic tests for human immunodeficiency virus were negative. The patient underwent orbital and cranial irradiation and intrathecal and systemic chemotherapy. Despite an initial response to treatment, she returned with a recurrence of the lymphoma in the anterior segment of the left eye. Her systemic disease progressed rapidly, and she died shortly thereafter. This patient's young age and initial presentation mimicking posterior scleritis with unilateral exudative retinal detachment, without evidence of vitreous involvement, are highly unusual for ocular involvement in primary CNS lymphoma. A review of the literature highlights the atypical nature of this presentation.

The New England journal of medicine, 1999

Review Article from The New England Journal of Medicine -- Treatment of Diabetic Retinopathy.

Clinical & Experimental Ophthalmology, 2016

Clin Exp Ophthalmol, 2003

ABSTRACT The purpose of the present paper was to describe the 5-year incidence and progression of... more ABSTRACT The purpose of the present paper was to describe the 5-year incidence and progression of diabetic retinopathy in the Melbourne Visual Impairment Project (VIP) cohort. Baseline examinations were conducted from 1992 to 1994 and follow-up data were collected 5 years later. Data collected during the baseline and follow-up studies included medical history (including previous diagnosis of diabetes mellitus) and dilated fundus examination. Two 30 degrees stereoscopic fundus photographs were taken with a Topcon TRC fundus camera, one centred on the optic disc and the other centred on the fovea. Photographs from participants who reported having diabetes were graded for diabetic retinopathy based on an extension of the Modified Airlie House Classification. Grouping of participant data into retinopathy grades was based on the results of the worst eye. The follow-up survey included 82% (n = 121) of those with diabetes at baseline. Prevalence of any retinopathy was 35.7% and macular oedema was 13% at follow up. Diabetic retinopathy was newly detected in 8/73 (5-year incidence = 11.0%, 95% confidence interval (CI) = 3.8-18.1). Disease progression was seen in 9/31 participants (29.0%, 95%CI = 14.9-47.8) who had diabetic retinopathy at baseline. The 5-year incidence of proliferative diabetic retinopathy in people without proliferative diabetic retinopathy at baseline was 2.9% (3/104, 95%CI = 0-6.4). The 5-year incidence of macular oedema in people who did not have macular oedema at baseline was 8.0% (8/100, 95%CI = 2.7-13.3). All people with proliferative diabetic retinopathy at baseline had received laser treatment by the follow-up survey. Twenty-four per cent of people without diabetic retinopathy reported never having had a dilated fundus examination (excluding the VIP examinations). The 5-year incidence of diabetic retinopathy was 11% in the Melbourne Visual Impairment Project. Most people with proliferative diabetic retinopathy or macular oedema are receiving treatment. However, many people with diabetes are not having regular dilated fundus examinations.

Clinical & Experimental Ophthalmology, 2015

The Medical journal of Australia, 2002

... Lionel M Kowal,* C Alex Harper *Director, Ocular Motility Clinic, Director, Medical Retina ... more ... Lionel M Kowal,* C Alex Harper *Director, Ocular Motility Clinic, Director, Medical Retina Clinic, Royal Victorian Eye and Ear Hospital ... Our preliminary recommendations (pending a prospective study) are: ■ If a patient has only one functioning eye (for whatever reason), an ...

Australian and New Zealand journal of ophthalmology, 1986

Combined hamartoma of the retina and retinal pigment epithelium (RPE), is a rare, benign, congeni... more Combined hamartoma of the retina and retinal pigment epithelium (RPE), is a rare, benign, congenital fundal lesion which contains a mixture of glial tissue, blood vessels and pigment epithelium. Such tumours are variably pigmented and may be wrongly diagnosed as malignant melanoma or retinoblastoma. We report two cases which were located in the periphery of the fundus and which produced a dragged disc appearance.

JAMA Ophthalmology, 2015

IMPORTANCE Topical phenylephrine hydrochloride is routinely administered with few safety precauti... more IMPORTANCE Topical phenylephrine hydrochloride is routinely administered with few safety precautions, but evidence regarding its systemic safety to date is controversial. As even short-term variations in 24-hour blood pressure (BP) and heart rate (HR) can adversely affect cardiovascular health, better evidence on phenylephrine's effects on HR and BP is required. OBJECTIVE To perform a meta-analysis of available evidence regarding cardiovascular adverse effects of topical phenylephrine. DATA SOURCES PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews and Clinical Trials were searched for relevant literature from January 1, 1970, to January 1, 2014, using a combination of the following search terms: topical, ocular, ophthalmic, phenylephrine, tropicamide, cardiovascular effect, side effect, blood pressure, heart rate, mydriatic, and eye drops. A total of 70 articles related to the topic were identified and all full texts were retrieved. STUDY SELECTION Randomized clinical trials reporting change in BP and HR for adults were included in this review. All studies reporting results for neonates or infants, not reporting standard deviations, or not specifying the time of measurement or the concentration of phenylephrine used were excluded. DATA EXTRACTION AND SYNTHESIS Data from randomized clinical trials that reported BP and/or HR as well as the time following administration of topical phenylephrine at which measurements were obtained by concentration of phenylephrine as a mean change and its standard deviation were extracted. Data were synthesized by concentration of phenylephrine and time of measurement following topical application using random-effects models with inverse variance weighting to account for heterogeneity across studies. MAIN OUTCOMES AND MEASURES Difference in BP and HR after topical administration of phenylephrine. RESULTS Eight RCTs with a total of 916 participants were included. Data were available for phenylephrine, 2.5%, at 20 to 30 minutes and 60 minutes or longer after administration, and neither BP nor HR changed at either time. Following application of phenylephrine, 10%, BP increased at 5 and 10 minutes (mean difference for both, +15 mm Hg; 95% CI, 11.94-18.54; P < .001) but decreased at 20 to 30 minutes and 60 minutes or longer with no changes detected against baseline. A mean increase in HR by 4.48 beats/min (95% CI, 1.09-7.88; P = .01) was present at 20 to 30 minutes following application of phenylephrine, 10%, and HR decreased by 60 minutes or longer with no changes detected compared with baseline. CONCLUSIONS AND RELEVANCE Phenylephrine, 2.5%, leads to no clinically relevant change in BP or HR, and the changes in BP and HR seen with phenylephrine, 10%, are short lived. Thus, phenylephrine, 2.5%, is safe to use in clinical routine.

The Medical journal of Australia, Jan 7, 2010

Journal of Angiogenesis Research, 2010

Background: Kallistatin, a serpin widely produced throughout the body, has vasodilatory, anti-ang... more Background: Kallistatin, a serpin widely produced throughout the body, has vasodilatory, anti-angiogenic, antioxidant, and anti-inflammatory effects. Effects of diabetes and its vascular complications on serum kallistatin levels are unknown. Methods: Serum kallistatin was quantified by ELISA in a cross-sectional study of 116 Type 1 diabetic patients (including 50 with and 66 without complications) and 29 non-diabetic controls, and related to clinical status and measures of oxidative stress and inflammation. Results: Kallistatin levels (mean(SD)) were increased in diabetic vs. control subjects (12.6(4.2) vs. 10.3(2.8) μg/ml, p = 0.007), and differed between diabetic patients with complications (13.4(4.9) μg/ml), complication-free patients (12.1 (3.7) μg/ml), and controls; ANOVA, p = 0.007. Levels were higher in diabetic patients with complications vs. controls, p = 0.01, but did not differ between complication-free diabetic patients and controls, p > 0.05. On univariate analyses, in diabetes, kallistatin correlated with renal dysfunction (cystatin C

Australian and New Zealand Journal of Ophthalmology, 1993

The biological mothers of 23 patients presenting with acute chorioretinal toxoplasmosis had sera ... more The biological mothers of 23 patients presenting with acute chorioretinal toxoplasmosis had sera screened for the presence of antibodies to Toxoplasma gondii. Twenty-two of the mothers (96%) had positive serology and one (4%) had negative serology. This is consistent with the hypothesis that most cases of ocular toxoplasmosis are congenital in origin, but indicates that some cases are due to acquired toxoplasmosis.

Stroke, 2008

Background and Purpose-There are concerns that cardiac catheterization may cause retinal emboliza... more Background and Purpose-There are concerns that cardiac catheterization may cause retinal embolization, a risk marker for cerebrovascular emboli and stroke. We describe the incidence of acute retinal embolism after cardiac catheterization. Methods-One hundred unselected patients attending a tertiary referral center for diagnostic cardiac catheterization were recruited. Digital retinal photography (optic disc and macular fields) was performed precatheterization and within 3 hours postcatheterization. New retinal emboli were identified by a senior researcher and confirmed by a retinal specialist. Results-There was one case of retinal embolus precatheterization. Two patients (incidence 2.02%; 95% CI, 0.25 to 7.11) developed new retinal arteriolar emboli after catheterization. No patient developed clinically apparent visual or neurological changes. Conclusions-The risk of acute retinal embolism immediately after cardiac catheterization is 2%. This finding indicates that the retinal, and possibly the cerebral circulation, may be compromised more frequently than is clinically apparent as a complication of cardiac catheterization.

Retinal Cases & Brief Reports, 2008

To report an occurrence of wound leak from the injection site after intravitreal injection of bev... more To report an occurrence of wound leak from the injection site after intravitreal injection of bevacizumab. A possible underlying etiology is discussed. A single injection of bevacizumab was given for treatment of choroidal neovascularization complicating previous choroidal rupture. A reduction in vision and hypotony were noted 1 day after injection. With conservative management, there was spontaneous resolution of the wound leak. The risk of wound leak after intravitreal injection may be higher for younger patients and those who have undergone vitrectomy. All patients and clinicians, however, should be alert to vision decline after injection, and prompt evaluation should be performed to ascertain the cause. For patients with persistent wound leak, surgical intervention may be required.

Retinal Cases & Brief Reports, 2007

To describe the optical coherence tomography (OCT) findings in two patients with welder&a... more To describe the optical coherence tomography (OCT) findings in two patients with welder&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s maculopathy. Retrospective cases series. In addition to examination by slit lamp biomicroscopy, color fundus photographs and OCT images were obtained from patients with welder&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s maculopathy. Both patients had a history of bilateral decreased central vision after welding without appropriate eye protection. Yellowish foveal spots developed in the acute stage, evolving over several months into well demarcated lamellar foveal defects with surrounding retinal pigment epithelium changes. OCT showed interruption of the inner high reflective layer (HRL) corresponding to the level of the outer neurosensory retina. These appearances are similar to those seen in solar maculopathy. OCT shows disruption of the inner HRL in late welder&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s maculopathy. These appearances are similar to those seen in late solar maculopathy. OCT can be a useful tool in confirming the diagnosis and understanding the pathogenesis of photic maculopathy.

Optometry and Vision Science, 2008

To determine the visual adaptation and retinal eccentricity profiles for red flickering and stati... more To determine the visual adaptation and retinal eccentricity profiles for red flickering and static test stimuli and report a clinical implementation of these stimuli in visual perimetry. The adaptation profile for red-on-white perimetry stimuli was measured using a threshold vs. intensity (TvI) paradigm at 0 degree and 12 degrees eccentricity and by comparing the eccentricity-related sensitivity change for red and white, static, and flickering targets in young normal trichromats (n = 5) and a group of dichromats (n = 5). A group of older normal control observers (n = 30) were tested and retinal disease was evaluated in persons having age-related maculopathy (n = 35) and diabetes (n = 12). Adaptation and eccentricity profiles indicate red static and flickering targets are detected by two mechanisms in the paramacular region, and a single mechanism for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5 degrees eccentricity. The group data for the older normal observers has a high level of inter-observer variability with a generalized reduction in sensitivity across the entire visual field. Group data for the participants with age-related maculopathy show reduced sensitivities that were pronounced in the central retina. The group data for the diabetic observers showed sensitivities that were reduced at all eccentricities. The disease-related sensitivity decline was more apparent with red than white stimuli. The adaptation profile and change in sensitivity with retinal eccentricity for the red-on-white perimetric stimuli are consistent with two detection processes. In the macula, the putative detection mechanism is color-opponent with static targets and non-opponent with flickering targets. At peripheral field locations, the putative detection mechanism is non-opponent for both static and flicker targets. The long-wavelength stimuli are less affected by the preretinal absorption common to aging. Red-on-white static and flicker perimetry may be useful for monitoring retinal disease, revealing greater abnormalities compared with conventional white-on-white perimetry, especially in the macula where two detection mechanisms are found.

Ophthalmology, 2008

Bevacizumab is an inhibitor of vascular endothelial growth factor widely used as an "off-label" t... more Bevacizumab is an inhibitor of vascular endothelial growth factor widely used as an "off-label" treatment of neovascular age-related macular degeneration (AMD), despite the lack of clinical trial data on efficacy or safety of this drug. We describe acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Design: A retrospective case series. Participants: Patients with neovascular AMD treated with intravitreous injection of bevacizumab from clinical practices in 2 states (Victoria and South Australia) in Australia. Methods: We retrospectively reviewed cases of acute intraocular inflammation after intravitreous injection of bevacizumab for the treatment of neovascular AMD. Main Outcome Measures: The detection and description of inflammation in a large cohort of patients. Results: There were 14 cases (11 women and 3 men), from a total of 1278 injections given. The mean age of patients was 83.7 years (range, 74-98). The majority had a prior injection of bevacizumab, with a mean number of injections of 2.7 (range, 1-6). Most patients presented within 24 hours of intravitreous injection, with rapid reduction in vision, but minimal discomfort. There were associated signs of ocular inflammation in the anterior and posterior segments of the eye. Visual acuity at presentation was substantially reduced compared with the preinjection acuity, although the vision rapidly improved with treatment over a period of 7-25 days toward preinjection visual acuity. Conclusions: Intravitreous injection of bevacizumab for the treatment of neovascular AMD may be associated with acute intraocular inflammation. Differentiation from infectious endophthalmitis is important for appropriate management of this condition.

Ophthalmology, 1990

Using histochemical staining techniques and electron microscopy, the authors have examined the hi... more Using histochemical staining techniques and electron microscopy, the authors have examined the histochemical properties and ultrastructure of Bruch's membrane in 30 human eyes with an age range of 1 to 95 years. The results analyzed in three age groups (0-30 years, 31-60 years, and older than 60 years) show that there is a progressive accumulation of lipids in Bruch's

Ophthalmic Epidemiology, 2000

Regular screening of all people with diabetes is the most efficient and cost-effective way to det... more Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.