Bita Manzouri - Academia.edu (original) (raw)

Papers by Bita Manzouri

Springer eBooks, Jan 27, 2006

∑ Allergic eye disease affects a reported 20% of the population worldwide and may be increasing i... more ∑ Allergic eye disease affects a reported 20% of the population worldwide and may be increasing in line with other atopic diseases, such as asthma, as a result of environmental factors∑ Other pathological mechanisms, in addition to the standard type I ...

International Ophthalmology, May 13, 2012

We describe a patient with severe atopic dermatitis and keratoconjunctivitis, who was prescribed ... more We describe a patient with severe atopic dermatitis and keratoconjunctivitis, who was prescribed both systemic and topical ciclosporin and who developed ocular surface squamous neoplasia (OSSN). To provide additional information on the incidence of the association between topical ciclosporin use and OSSN, we counted the total prescriptions for topical ciclosporin issued in our hospital between 2003 and 2006 (804 patients) and, for the same period, we reviewed the records of patients with OSSN for a history of treatment with ciclosporin or a history of atopy. No other case of OSSN in a patient with a history of topical ciclosporin use was identified, which makes it difficult to implicate topical ciclosporin as the causative factor.

Eye, Dec 19, 2008

Purpose Dendritic cells (DCs) express the high-affinity receptor for IgE (FceRI) on their surface... more Purpose Dendritic cells (DCs) express the high-affinity receptor for IgE (FceRI) on their surface, which may enhance their ability to capture and internalize antigens for presentation to T-lymphocytes. The aim of this study was to determine if expression of FceRI þ DCs is increased in the conjunctivae of vernal keratoconjunctivitis (VKC) patients compared with those of normal controls. Methods Conjunctival biopsies were obtained from non-atopic and VKC patients. Double immunohistochemical staining was carried out using antibodies against FceRI and the CD1a antigen, a DC marker. The doublepositive cells were counted in five representative fields of view for each conjunctival sample. Results FceRI þ CD1a þ cells were present in significantly higher numbers in VKC conjunctivae compared with normal controls (mean cell count of 21.3 in VKC vs 5.0 in controls, Po0.005). In normal patients the FceRI-expressing DCs tended to be confined to the epithelial layer or the superficial substantia propria, but in the VKC samples these FceRI þ cells were mainly concentrated in the deeper substantia propria. Conclusions FceRI þ DC numbers are elevated in the conjunctivae of VKC patients, a finding consistent with the results of other studies focusing on atopic conditions. Elevated expression of FceRI on DCs would facilitate antigen presentation and enhance T-cell priming, thereby contributing to ocular symptoms.

Expert Opinion on Pharmacotherapy, May 30, 2006

Allergic eye disease is a term that refers to a number of disease processes that affect about one... more Allergic eye disease is a term that refers to a number of disease processes that affect about one-fifth of the world's population. Although the more advanced forms of the disease can be sight threatening, the most disabling effects are due to the clinical manifestations, and hence quality of life, with some patients having seasonal exacerbations of their symptoms, whereas others have symptoms that are present throughout the year. Recent increased understanding of the cellular and mediator mechanisms that are involved in the various disease manifestations has greatly facilitated the development of more effective treatment options. Newer topical medications are being used that have multiple actions, such as an antihistaminic effect coupled with mast-cell stabilisation, and which require reduced daily dosing due to their longer duration of action. With greater research into newer therapies and more effective modes of delivery, improved healthcare outcomes with a lower economic burden will be achieved for patients with allergic eye disease.

Investigative Ophthalmology & Visual Science, May 10, 2007

Eye & Contact Lens-science and Clinical Practice, Nov 1, 2013

Conjunctival papillomata are squamous epithelial tumors with a strong association with human papi... more Conjunctival papillomata are squamous epithelial tumors with a strong association with human papilloma virus (HPV) types 6 and 11. They are benign conjunctival tumors that can be treated by surgical excision. We report a case where topical immunosuppressive therapy modified the local T-cell immunity in the conjunctiva resulting in papilloma development in a patient with keratoconus and a strong atopic history. Methods: A case report of a 44-year-old man with a history of severe ocular and generalized atopy is presented. We present the problems encountered in management of his severe ocular allergy and how these impeded the management of his keratoconus. Results: Conventional antiallergy topical medication was not producing symptom relief in this patient, and so topical immunosuppression was commenced using ciclosporin ointment 0.2%. This therapy modified the local T-cell immunity in the conjunctiva resulting in the development of papillomata which contributed to the intolerance of contact lens wear for visual rehabilitation of the keratoconus in the patient. These lesions were surgically removed but typically recurred and required further surgical excision. Adjunct cryotherapy was also performed at the time of the surgery to try to stem the recurrence of the papillomas. Conclusions: To the best of our knowledge and following a review of the published literature using key databases that include Medline and PubMed, this is the first report confirming the development of conjunctival papillomas secondary to HPV type 6 in a ciclosporin-treated patient.

British Journal of Ophthalmology, Aug 30, 2010

Background: Dendritic cells (DCs) are the most potent antigen-presenting cells involved in initia... more Background: Dendritic cells (DCs) are the most potent antigen-presenting cells involved in initiating the immune response, presenting antigens to T cells and leading to T cell proliferation. In an immature state, DCs lack accessory signals required for T cell stimulation but are highly specialized to capture antigens. Full DC maturation changes the cell surface phenotype and facilitates stimulation of T cell proliferative responses. To examine the degree of DC maturity associated with vernal keratoconjunctivitis (VKC), we examined the phenotype and antigenpresentation capability of blood derived DCs from VKC patients and from normal controls. Methods: Flow cytometry was used to identify the cell surface expression of markers of DC maturity (CD83, CD86, MHC class II) and mixed leukocyte reactions to assess DC induction of T cell proliferation. Results: DCs derived from VKC patients were of more mature phenotype than those from normal controls. However, these VKC DCs had reduced capability for induction of T cell proliferation compared to DCs from controls. Conclusion: The increased maturity of DCs in VKC patients correlates with the heightened immune responsiveness associated with this disorder. A number of mechanisms may underlie the impaired ability of DCs in atopy to stimulate T cell proliferation. This impairment of DC induction of T cell activation is likely to be one factor which contributes to the modified inflammatory response seen in VKC patients and the recognised susceptibility of these patients to viral infection.

Essentials in ophthalmology, 2019

Multifocal lenses provide an effective and predictable surgical option for spectacle-free vision ... more Multifocal lenses provide an effective and predictable surgical option for spectacle-free vision following refractive lens exchange or post cataract surgery. Rayner multifocal IOLs are available in two main designs: capsular-fixated and sulcus- fixated. The capsular-fixated M-flex and M-flex T are based on a closed-loop haptic system (anti-vaulting haptics) to provide good lens centration. They have a 3600 square edge design to minimise the risk of posterior capsular opacification. The M-flex T provides patients with corneal astigmatism of >1.5 D a viable option for reducing spectacle dependance. The Rayner RayOne Trifocal is a capsular-fixated lens designed to provide good distance, intermediate and near vision. It confers many benefits of the multifocal range including anti-vaulting haptics and a square edge design. The sulcus-placed lenses (Sulcoflex multifocal, Sulcoflex multifocal toric and Sulcoflex trifocal) have similar optics to their capsular-fixated counterparts but of lower spherical power as they are supplemental IOLs. These are versatile lenses that have five primary use cases: (1) primary duet procedure, (2) secondary duet procedure, (3) duet conversion procedure, (4) duet deconversion procedure and (5) treatment of negative dysphotopsia.

Journal of Pediatric Ophthalmology & Strabismus, 2023

Advances in Experimental Medicine and Biology, 2010

Ocular allergy is a disorder affecting increasing numbers of individuals worldwide. Among the inf... more Ocular allergy is a disorder affecting increasing numbers of individuals worldwide. Among the inflammatory mediators that contribute to ocular allergy, histamine is perhaps the best characterized. This monoamine is released by sensitized mast cells upon exposure to allergen and causes symptoms such as redness and tearing. Histamine may also recruit immune cells that can cause long-term damage to ocular surfaces. In this chapter we will discuss the known functions of histamine and histamine receptors in ocular allergy and will describe promising therapies targeting the histamine-signaling pathway.

Ocular Surface, Apr 1, 2008

The acquired immune response in health and disease is initiated when foreign antigens are process... more The acquired immune response in health and disease is initiated when foreign antigens are processed and presented to T lymphocytes via antigen-presenting cells as peptides in the context of Class I and II major histocompatibility complex antigens. It is now clear that there are various types of antigen-presenting cells and that the phenotype of these cells (together with the milieu of the tissue or lymphoid organ) dictates the nature of the immune response to the antigen. Very little is known about the phenotype, distribution, and roles of dendritic cell subtypes that contribute to the pathophysiology of type I hypersensitivity reaction in the ocular surface. We review what has been learned from studies of both human ocular allergy and murine models and comment on how this compares to allergic reactions in other mucosal tissues. KEY WORDS allergy, antigen-presenting cell, conjunctivitis, dendritic cell, T lymphocyte

Expert Opinion on Pharmacotherapy, Nov 1, 2001

Fungal eye infections are rare. Trauma associated with contamination by vegetative material, cont... more Fungal eye infections are rare. Trauma associated with contamination by vegetative material, contact lens wear and long term corticosteroid use are common risk factors. The aims of treatment are to preserve visual function, which depends on the rapid diagnosis and efficient administration of appropriate antifungal therapy. This necessitates a clinical suspicion of fungal aetiology and the taking of appropriate smears and cultures as early as possible to identify the fungal organism. Currently there are three main classes of drugs available for use in fungal eye infections: polyenes, azoles as derivatives of imidazoles, and 5-fluorocytosine. Of the polyenes, amphotericin B, natamycin and nystatin are of clinical ophthalmic use. Based on better pharmacokinetic profiles and spectra of antifungal activity, the triazoles are the agents of choice. Successful treatment of fungal keratitis depends on early initiation of specific therapy consisting of topically-applied antifungal agents since topical administration is most likely to provide the best opportunity for achieving therapeutic corneal levels. Hence, the molecular weight of the various antifungal agents is of importance since it influences their ability to penetrate the corneal epithelium. Systemic administration may be necessary for resistant fungal ulcers. For fungal endophthalmitis, to preserve visual function and eliminate the fungal pathogen, topical, systemic and possibly intraocular antifungal therapy is used, although some do not recommend use of systemic agents for exogenous endophthalmitis.

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2010

Experimental and Molecular Pathology, Oct 1, 2007

Dendritic cells (DCs) are a subset of antigen-presenting cells (APCs) that are involved in the in... more Dendritic cells (DCs) are a subset of antigen-presenting cells (APCs) that are involved in the initiation and control of the immune response to antigens present at the interface with the environment. A limited number of groups have studied DCs in human and animal conjunctiva but no data is available concerning the different DC subsets present in the conjunctival tissue. The aims of this study are to characterize the phenotypes and numbers of DCs present in the murine model of allergic conjunctivitis using the technique of immunohistochemistry so as to aid the understanding of the mechanisms involved in allergic eye disease. A double immunofluorescence method was used to analyze the phenotypic distribution and density of DC subsets in the mouse conjunctival tissues of the allergic model using a panel of antibodies: CD11c, as a general marker of DCs, coupled with another DC subset marker such as Langerin for Langerhans cells (LCs), CD11b for myeloid DCs (mDCs) and mPDCA-1 for plasmacytoid DCs (pDCs). In the naïve conjunctiva, mDCs were consistently detected in the subepithelial layer and substantia propria. In the epithelium and the subepithelial layer, very few LCs and virtually no pDCs were observed. Following allergen challenge, there was a marked influx of mDCs and pDCs, but no LCs, into the subepithelial layer and throughout the substantia propria. These results indicate that conjunctival DC subsets may play an important role in the immune-regulatory processes involved in the inflammatory component of allergic conjunctivitis.

Investigative Ophthalmology & Visual Science, May 1, 2006

Asia-Pacific journal of ophthalmology, 2017

Supplemental intraocular lenses (IOLs) have been developed to replace IOLs designed for in-the-ba... more Supplemental intraocular lenses (IOLs) have been developed to replace IOLs designed for in-the-bag placement being used as "piggy-back" IOLs in the sulcus due to unacceptable complications. The new IOLs have unique platform designs to avoid these complications. As a result, a new nomenclature is needed to describe the 4 scenarios when supplemental IOL use is now indicated.

Springer eBooks, 2014

Multifocal IOLs are the most predictable way to treat presbyopia surgically, affording most posto... more Multifocal IOLs are the most predictable way to treat presbyopia surgically, affording most postoperative cataract or refractive lens exchange (PRELEX) patients spectacle-free vision. Rayner multifocal IOLs are based on one of two platforms for either capsular fixation or sulcus placement and are notable for using refractive optics with two add powers. Refractive optics utilises all available light for images that can be visualised, and so this design does not waste light. This means that for well-designed refractive multifocal IOLs, the loss of contrast sensitivity is below most patient’s threshold of appreciation. The capsular-fixated M-flex and M-flex T are based on a closed-loop haptic system platform (anti-vaulting haptics) which allow for good centration of the lens. Additionally, these lenses have a 360° square edge, minimising the risk of posterior capsular opacification. While standard multifocal IOLs are often contraindicated for patients with >1.5 D of corneal astigmatism, the combination of multifocal and toric optical components found in the M-flex T offers the potential benefit of reduced spectacle dependence to be extended to patients with significant corneal astigmatism. The sulcus-placed Sulcoflex IOLs (Sulcoflex Multifocal and Sulcoflex Multifocal Toric) have optics that are essentially the same as for the M-flex and M-flex T but of much lower spherical power (although the adds are the same) and are designed as supplemental IOLs to correct residual refractive error or to convert from monofocal to multifocal optics when implanted in already pseudophakic eyes. Rayner multifocal IOLs have a very low incidence of haloes, leading to the hypothesis that the particularly low index of refraction (1.46) of “Rayacryl”, the hydrophilic acrylic material used to manufacture the IOLs, is a major contributory factor. These lenses are all injected using the injector common to all Rayner IOLs, meaning that there is a minimal learning curve.

Springer eBooks, Jan 27, 2006

∑ Allergic eye disease affects a reported 20% of the population worldwide and may be increasing i... more ∑ Allergic eye disease affects a reported 20% of the population worldwide and may be increasing in line with other atopic diseases, such as asthma, as a result of environmental factors∑ Other pathological mechanisms, in addition to the standard type I ...

International Ophthalmology, May 13, 2012

We describe a patient with severe atopic dermatitis and keratoconjunctivitis, who was prescribed ... more We describe a patient with severe atopic dermatitis and keratoconjunctivitis, who was prescribed both systemic and topical ciclosporin and who developed ocular surface squamous neoplasia (OSSN). To provide additional information on the incidence of the association between topical ciclosporin use and OSSN, we counted the total prescriptions for topical ciclosporin issued in our hospital between 2003 and 2006 (804 patients) and, for the same period, we reviewed the records of patients with OSSN for a history of treatment with ciclosporin or a history of atopy. No other case of OSSN in a patient with a history of topical ciclosporin use was identified, which makes it difficult to implicate topical ciclosporin as the causative factor.

Eye, Dec 19, 2008

Purpose Dendritic cells (DCs) express the high-affinity receptor for IgE (FceRI) on their surface... more Purpose Dendritic cells (DCs) express the high-affinity receptor for IgE (FceRI) on their surface, which may enhance their ability to capture and internalize antigens for presentation to T-lymphocytes. The aim of this study was to determine if expression of FceRI þ DCs is increased in the conjunctivae of vernal keratoconjunctivitis (VKC) patients compared with those of normal controls. Methods Conjunctival biopsies were obtained from non-atopic and VKC patients. Double immunohistochemical staining was carried out using antibodies against FceRI and the CD1a antigen, a DC marker. The doublepositive cells were counted in five representative fields of view for each conjunctival sample. Results FceRI þ CD1a þ cells were present in significantly higher numbers in VKC conjunctivae compared with normal controls (mean cell count of 21.3 in VKC vs 5.0 in controls, Po0.005). In normal patients the FceRI-expressing DCs tended to be confined to the epithelial layer or the superficial substantia propria, but in the VKC samples these FceRI þ cells were mainly concentrated in the deeper substantia propria. Conclusions FceRI þ DC numbers are elevated in the conjunctivae of VKC patients, a finding consistent with the results of other studies focusing on atopic conditions. Elevated expression of FceRI on DCs would facilitate antigen presentation and enhance T-cell priming, thereby contributing to ocular symptoms.

Expert Opinion on Pharmacotherapy, May 30, 2006

Allergic eye disease is a term that refers to a number of disease processes that affect about one... more Allergic eye disease is a term that refers to a number of disease processes that affect about one-fifth of the world's population. Although the more advanced forms of the disease can be sight threatening, the most disabling effects are due to the clinical manifestations, and hence quality of life, with some patients having seasonal exacerbations of their symptoms, whereas others have symptoms that are present throughout the year. Recent increased understanding of the cellular and mediator mechanisms that are involved in the various disease manifestations has greatly facilitated the development of more effective treatment options. Newer topical medications are being used that have multiple actions, such as an antihistaminic effect coupled with mast-cell stabilisation, and which require reduced daily dosing due to their longer duration of action. With greater research into newer therapies and more effective modes of delivery, improved healthcare outcomes with a lower economic burden will be achieved for patients with allergic eye disease.

Investigative Ophthalmology & Visual Science, May 10, 2007

Eye & Contact Lens-science and Clinical Practice, Nov 1, 2013

Conjunctival papillomata are squamous epithelial tumors with a strong association with human papi... more Conjunctival papillomata are squamous epithelial tumors with a strong association with human papilloma virus (HPV) types 6 and 11. They are benign conjunctival tumors that can be treated by surgical excision. We report a case where topical immunosuppressive therapy modified the local T-cell immunity in the conjunctiva resulting in papilloma development in a patient with keratoconus and a strong atopic history. Methods: A case report of a 44-year-old man with a history of severe ocular and generalized atopy is presented. We present the problems encountered in management of his severe ocular allergy and how these impeded the management of his keratoconus. Results: Conventional antiallergy topical medication was not producing symptom relief in this patient, and so topical immunosuppression was commenced using ciclosporin ointment 0.2%. This therapy modified the local T-cell immunity in the conjunctiva resulting in the development of papillomata which contributed to the intolerance of contact lens wear for visual rehabilitation of the keratoconus in the patient. These lesions were surgically removed but typically recurred and required further surgical excision. Adjunct cryotherapy was also performed at the time of the surgery to try to stem the recurrence of the papillomas. Conclusions: To the best of our knowledge and following a review of the published literature using key databases that include Medline and PubMed, this is the first report confirming the development of conjunctival papillomas secondary to HPV type 6 in a ciclosporin-treated patient.

British Journal of Ophthalmology, Aug 30, 2010

Background: Dendritic cells (DCs) are the most potent antigen-presenting cells involved in initia... more Background: Dendritic cells (DCs) are the most potent antigen-presenting cells involved in initiating the immune response, presenting antigens to T cells and leading to T cell proliferation. In an immature state, DCs lack accessory signals required for T cell stimulation but are highly specialized to capture antigens. Full DC maturation changes the cell surface phenotype and facilitates stimulation of T cell proliferative responses. To examine the degree of DC maturity associated with vernal keratoconjunctivitis (VKC), we examined the phenotype and antigenpresentation capability of blood derived DCs from VKC patients and from normal controls. Methods: Flow cytometry was used to identify the cell surface expression of markers of DC maturity (CD83, CD86, MHC class II) and mixed leukocyte reactions to assess DC induction of T cell proliferation. Results: DCs derived from VKC patients were of more mature phenotype than those from normal controls. However, these VKC DCs had reduced capability for induction of T cell proliferation compared to DCs from controls. Conclusion: The increased maturity of DCs in VKC patients correlates with the heightened immune responsiveness associated with this disorder. A number of mechanisms may underlie the impaired ability of DCs in atopy to stimulate T cell proliferation. This impairment of DC induction of T cell activation is likely to be one factor which contributes to the modified inflammatory response seen in VKC patients and the recognised susceptibility of these patients to viral infection.

Essentials in ophthalmology, 2019

Multifocal lenses provide an effective and predictable surgical option for spectacle-free vision ... more Multifocal lenses provide an effective and predictable surgical option for spectacle-free vision following refractive lens exchange or post cataract surgery. Rayner multifocal IOLs are available in two main designs: capsular-fixated and sulcus- fixated. The capsular-fixated M-flex and M-flex T are based on a closed-loop haptic system (anti-vaulting haptics) to provide good lens centration. They have a 3600 square edge design to minimise the risk of posterior capsular opacification. The M-flex T provides patients with corneal astigmatism of >1.5 D a viable option for reducing spectacle dependance. The Rayner RayOne Trifocal is a capsular-fixated lens designed to provide good distance, intermediate and near vision. It confers many benefits of the multifocal range including anti-vaulting haptics and a square edge design. The sulcus-placed lenses (Sulcoflex multifocal, Sulcoflex multifocal toric and Sulcoflex trifocal) have similar optics to their capsular-fixated counterparts but of lower spherical power as they are supplemental IOLs. These are versatile lenses that have five primary use cases: (1) primary duet procedure, (2) secondary duet procedure, (3) duet conversion procedure, (4) duet deconversion procedure and (5) treatment of negative dysphotopsia.

Journal of Pediatric Ophthalmology & Strabismus, 2023

Advances in Experimental Medicine and Biology, 2010

Ocular allergy is a disorder affecting increasing numbers of individuals worldwide. Among the inf... more Ocular allergy is a disorder affecting increasing numbers of individuals worldwide. Among the inflammatory mediators that contribute to ocular allergy, histamine is perhaps the best characterized. This monoamine is released by sensitized mast cells upon exposure to allergen and causes symptoms such as redness and tearing. Histamine may also recruit immune cells that can cause long-term damage to ocular surfaces. In this chapter we will discuss the known functions of histamine and histamine receptors in ocular allergy and will describe promising therapies targeting the histamine-signaling pathway.

Ocular Surface, Apr 1, 2008

The acquired immune response in health and disease is initiated when foreign antigens are process... more The acquired immune response in health and disease is initiated when foreign antigens are processed and presented to T lymphocytes via antigen-presenting cells as peptides in the context of Class I and II major histocompatibility complex antigens. It is now clear that there are various types of antigen-presenting cells and that the phenotype of these cells (together with the milieu of the tissue or lymphoid organ) dictates the nature of the immune response to the antigen. Very little is known about the phenotype, distribution, and roles of dendritic cell subtypes that contribute to the pathophysiology of type I hypersensitivity reaction in the ocular surface. We review what has been learned from studies of both human ocular allergy and murine models and comment on how this compares to allergic reactions in other mucosal tissues. KEY WORDS allergy, antigen-presenting cell, conjunctivitis, dendritic cell, T lymphocyte

Expert Opinion on Pharmacotherapy, Nov 1, 2001

Fungal eye infections are rare. Trauma associated with contamination by vegetative material, cont... more Fungal eye infections are rare. Trauma associated with contamination by vegetative material, contact lens wear and long term corticosteroid use are common risk factors. The aims of treatment are to preserve visual function, which depends on the rapid diagnosis and efficient administration of appropriate antifungal therapy. This necessitates a clinical suspicion of fungal aetiology and the taking of appropriate smears and cultures as early as possible to identify the fungal organism. Currently there are three main classes of drugs available for use in fungal eye infections: polyenes, azoles as derivatives of imidazoles, and 5-fluorocytosine. Of the polyenes, amphotericin B, natamycin and nystatin are of clinical ophthalmic use. Based on better pharmacokinetic profiles and spectra of antifungal activity, the triazoles are the agents of choice. Successful treatment of fungal keratitis depends on early initiation of specific therapy consisting of topically-applied antifungal agents since topical administration is most likely to provide the best opportunity for achieving therapeutic corneal levels. Hence, the molecular weight of the various antifungal agents is of importance since it influences their ability to penetrate the corneal epithelium. Systemic administration may be necessary for resistant fungal ulcers. For fungal endophthalmitis, to preserve visual function and eliminate the fungal pathogen, topical, systemic and possibly intraocular antifungal therapy is used, although some do not recommend use of systemic agents for exogenous endophthalmitis.

Jaypee Brothers Medical Publishers (P) Ltd. eBooks, 2010

Experimental and Molecular Pathology, Oct 1, 2007

Dendritic cells (DCs) are a subset of antigen-presenting cells (APCs) that are involved in the in... more Dendritic cells (DCs) are a subset of antigen-presenting cells (APCs) that are involved in the initiation and control of the immune response to antigens present at the interface with the environment. A limited number of groups have studied DCs in human and animal conjunctiva but no data is available concerning the different DC subsets present in the conjunctival tissue. The aims of this study are to characterize the phenotypes and numbers of DCs present in the murine model of allergic conjunctivitis using the technique of immunohistochemistry so as to aid the understanding of the mechanisms involved in allergic eye disease. A double immunofluorescence method was used to analyze the phenotypic distribution and density of DC subsets in the mouse conjunctival tissues of the allergic model using a panel of antibodies: CD11c, as a general marker of DCs, coupled with another DC subset marker such as Langerin for Langerhans cells (LCs), CD11b for myeloid DCs (mDCs) and mPDCA-1 for plasmacytoid DCs (pDCs). In the naïve conjunctiva, mDCs were consistently detected in the subepithelial layer and substantia propria. In the epithelium and the subepithelial layer, very few LCs and virtually no pDCs were observed. Following allergen challenge, there was a marked influx of mDCs and pDCs, but no LCs, into the subepithelial layer and throughout the substantia propria. These results indicate that conjunctival DC subsets may play an important role in the immune-regulatory processes involved in the inflammatory component of allergic conjunctivitis.

Investigative Ophthalmology & Visual Science, May 1, 2006

Asia-Pacific journal of ophthalmology, 2017

Supplemental intraocular lenses (IOLs) have been developed to replace IOLs designed for in-the-ba... more Supplemental intraocular lenses (IOLs) have been developed to replace IOLs designed for in-the-bag placement being used as "piggy-back" IOLs in the sulcus due to unacceptable complications. The new IOLs have unique platform designs to avoid these complications. As a result, a new nomenclature is needed to describe the 4 scenarios when supplemental IOL use is now indicated.

Springer eBooks, 2014

Multifocal IOLs are the most predictable way to treat presbyopia surgically, affording most posto... more Multifocal IOLs are the most predictable way to treat presbyopia surgically, affording most postoperative cataract or refractive lens exchange (PRELEX) patients spectacle-free vision. Rayner multifocal IOLs are based on one of two platforms for either capsular fixation or sulcus placement and are notable for using refractive optics with two add powers. Refractive optics utilises all available light for images that can be visualised, and so this design does not waste light. This means that for well-designed refractive multifocal IOLs, the loss of contrast sensitivity is below most patient’s threshold of appreciation. The capsular-fixated M-flex and M-flex T are based on a closed-loop haptic system platform (anti-vaulting haptics) which allow for good centration of the lens. Additionally, these lenses have a 360° square edge, minimising the risk of posterior capsular opacification. While standard multifocal IOLs are often contraindicated for patients with >1.5 D of corneal astigmatism, the combination of multifocal and toric optical components found in the M-flex T offers the potential benefit of reduced spectacle dependence to be extended to patients with significant corneal astigmatism. The sulcus-placed Sulcoflex IOLs (Sulcoflex Multifocal and Sulcoflex Multifocal Toric) have optics that are essentially the same as for the M-flex and M-flex T but of much lower spherical power (although the adds are the same) and are designed as supplemental IOLs to correct residual refractive error or to convert from monofocal to multifocal optics when implanted in already pseudophakic eyes. Rayner multifocal IOLs have a very low incidence of haloes, leading to the hypothesis that the particularly low index of refraction (1.46) of “Rayacryl”, the hydrophilic acrylic material used to manufacture the IOLs, is a major contributory factor. These lenses are all injected using the injector common to all Rayner IOLs, meaning that there is a minimal learning curve.