Peter McCluskey | The University of Sydney (original) (raw)

Papers by Peter McCluskey

Nutrition reviews, 2015

Age-related macular degeneration (AMD) causes a significant proportion of visual loss in the deve... more Age-related macular degeneration (AMD) causes a significant proportion of visual loss in the developed world. Currently, little is known about its pathogenesis, and treatment options are limited. Dietary intake is one of the few modifiable risk factors for this condition. The best-validated therapies remain oral antioxidant supplements based on those investigated in the Age-Related Eye Disease Study (AREDS) and the recently completed Age-Related Eye Disease Study 2 (AREDS2). In this review, current dietary guidelines related to AMD, along with the underlying evidence to support them, are presented in conjunction with current treatment recommendations. Both AREDS and AREDS2 are discussed, as are avenues for further research, including supplementation with vitamin D and saffron. Despite the considerable disease burden of atrophic AMD, few effective therapies are available to treat it, and further research is required.

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 2001

To assess the safety and efficacy of upper eyelid gold weight implants in managing paralytic lago... more To assess the safety and efficacy of upper eyelid gold weight implants in managing paralytic lagophthalmos and to compare two surgical techniques for their insertion. Retrospective case series. Tertiary referral center. One hundred four patients had a gold weight implanted for paralytic lagophthalmos between 1982 and 1996 at the Royal Prince Alfred Hospital in Sydney. Each patient had more than 2 years of follow-up of lid load function. The effectiveness of gold weights in reanimating eyelid closure, mean duration of gold weight retention, reasons for removal, and complications resulting from a gold weight; these outcomes were also compared using two surgical techniques for gold weight insertion. One hundred three patients maintained corneal integrity. At the time of assessment, 46 patients had had their lid loads removed from their eyelids, and 58 lid loads remained in situ. Of the lid loads that were removed, 78% were because the facial nerve had recovered. The remaining 22% were ...

The Medical journal of Australia, Jan 3, 2014

To determine the incidence of surfboard-related eye injuries (SREIs) in New South Wales in 1 year... more To determine the incidence of surfboard-related eye injuries (SREIs) in New South Wales in 1 year. Prospective questionnaire-based study of SREIs through reporting on injuries, treatment and outcomes by ophthalmologists and ophthalmology trainees in NSW and by patients of all ages with any SREIs on risk factors for SREIs that occurred between 30 December 2010 and 30 December 2011. Incidence, nature and severity of SREIs, defined as any injury to the eye, orbit or eyelid caused by a surfboard. 10 cases of SREIs were reported. Eight patients were male. The mean age of injured patients was 35.4 years. Two of the patients were children. Patients often had a combination of ophthalmic injuries. There were two globe ruptures, four fractured orbits, one case of fibreglass foreign bodies in the orbit and six eyelid lacerations. SREIs were caused by all sharp projections of the surfboard including the nose, fins and tail. This study confirms that surfing carries a small risk of eye trauma and...

BMJ case reports, 2011

Both intracranial hypertension and keratoconus may be associated with visual impairment. The auth... more Both intracranial hypertension and keratoconus may be associated with visual impairment. The authors present a case of a young female with poor right vision that did not improve despite treatment of her intracranial hypertension. Ophthalmic consultation diagnosed keratoconus as the cause.

The Journal of trauma, 1999

A study was performed to determine the type and frequency of ocular injuries in patients with maj... more A study was performed to determine the type and frequency of ocular injuries in patients with major trauma. All patients with ocular and adnexal injuries (n = 178) among 1,119 patients admitted with major trauma (Injury Severity Score >15) to the Royal Prince Alfred Hospital from July 1990 to December 1997 were analyzed. Sixteen percent of the major trauma cohort had ocular or orbital trauma. Fifty-five percent of patients with injuries involving the face had ocular or orbital injuries. A range of ocular injuries was seen. Analysis of the major trauma cohort showed that motor vehicle drivers, orbital and base of skull fractures, eyelid lacerations, and superficial eye injuries were strongly associated with vision-threatening injury. Patients with major trauma and facial injuries have a high risk of vision-threatening injury. Patients with orbital fractures, base of skull fracture, eyelid lacerations, and superficial eye injuries should be assessed by an ophthalmologist as part of...

Australian and New Zealand journal of ophthalmology, 1986

Over a five-year period 245 patients with uveitis were investigated at the Uveitis Clinic, Sydney... more Over a five-year period 245 patients with uveitis were investigated at the Uveitis Clinic, Sydney Eye Hospital, for possible aetiological and relevant disease associations. Uveitis was anterior in 75% of patients, posterior in 21% and generalized in 4%. Anterior uveitis (AU) was idiopathic in 52% of cases. In patients tested for the HLA-B27 antigen, 47% were HLA-B27 positive, including all cases of ankylosing spondylitis (8% of cases) and Reiter's syndrome (3% of cases). There was a marked male predominance in patients with AU, especially in HLA-B27 positive individuals. Posterior uveitis (PU) was most frequently unilateral, chronic and idiopathic (24% of cases), whilst recognizable aetiologies included toxoplasmosis (20%), Behcet's syndrome (14%), sarcoidosis (12%) and pars planitis (12%). The peak age of onset in patients presenting with AU was 30 to 40 years, whilst patients with PU presented a decade earlier. There were no major differences between males and females in t...

Ophthalmology, 2015

Objective: To ascertain whether patients on long-term systemic immunosuppressive therapy for infl... more Objective: To ascertain whether patients on long-term systemic immunosuppressive therapy for inflammatory eye disease (IED) are at increased risk of malignancy.

Clinical and Experimental Ophthalmology, 2004

Few studies have addressed quality of life or satisfaction outcomes for patients undergoing catar... more Few studies have addressed quality of life or satisfaction outcomes for patients undergoing cataract surgery, particularly in Australia. The purpose of this study was to describe a sample of patients undergoing cataract surgery in typical metropolitan practices in Sydney, with a particular focus on the impact upon quality of life and satisfaction with vision. One hundred and eleven patients were recruited prior to surgery and followed through 3 months postoperatively. Patients reported basic demographic information, VF-14 visual disability and SF-36 quality of life information, along with the degree of satisfaction and trouble with vision they experienced. Surgeons&amp;amp;amp;amp;amp;amp;amp;#39; records provided information about type and severity of cataract, refractive error, ocular comorbidity and visual acuity. Patients enjoyed strongly significant improvement in visual acuity, disability, trouble and satisfaction with vision, with a median postoperative Snellen acuity of 6/7.5, and 82% within 1 D refraction. Not wearing glasses was the most commonly stated patient goal for undergoing surgery. Prior to surgery 23% of all driving patients did so illegally due to poor vision; after surgery 21% of non-drivers began driving again, all legally. Nonetheless, quality of life did not improve. Those who failed to achieve improvements in satisfaction with vision were more likely to be female, have lower educational attainment or have high visual function preoperatively. Change in visual acuity was not predictive. The findings from this study indicate that cataract surgery outcomes in Australia compare well with international standards, and emphasize the inadequacy of visual acuity to measure relevant surgical outcomes. Increased preoperative counselling may be required in those groups less likely to attain high levels of satisfaction. Finally, the role of cataract surgery to improve quality of life must be investigated further, as this is the ultimate goal of the procedure.

Journal of the renin-angiotensin-aldosterone system : JRAAS, Jan 6, 2014

The purpose of this study was to determine the relative expression of clinically-relevant compone... more The purpose of this study was to determine the relative expression of clinically-relevant components of the renin-angiotensin system (RAS) in the adult human eye. We obtained 14 post-mortem enucleated human eyes from patients whom had no history of inflammatory ocular disease nor pre-mortem ocular infection. We determined the gene expression for prorenin, renin, prorenin receptor, angiotensin-converting enzyme, angiotensinogen and angiotensin II Type 1 receptor, on tissue sections and in cultured human primary retinal pigment epithelial and iris pigment epithelial (RPE/IPE) cell lines, using both qualitative and quantitative reverse transcription polymerase chain reaction (RT-PCR). Protein expression was studied using indirect immunofluorescence (IF). Almost all components of the classical RAS were found at high levels, at both the transcript and protein level, in the eyes' uvea and retina; and at lower levels in the cornea, conjunctiva and sclera. There was a much lower level o...

Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, Jan 24, 2014

Cataract is one of the leading causes of visual impairment in Australia. As more older adults are... more Cataract is one of the leading causes of visual impairment in Australia. As more older adults are driving, the number of people with cataract on the roads will increase. A greater understanding of the effects of cataract and cataract surgery on driving performance and driver self-regulation is essential to improve road safety. This proposed study will examine the effects of bilateral cataract surgery on driving outcomes including driving performance and driver self-regulation. A 3-year prospective study will be undertaken in Western Australia (WA) and New South Wales (NSW). Three hundred participants (n=150 from WA and n=150 from NSW) aged >60 years with bilateral cataract will be assessed at three time points: the month before first-eye cataract surgery, 1-3 months after first-eye cataract surgery and 3 months after second-eye cataract surgery. Driving performance will be assessed using a driving simulator and driver self-regulation patterns measured using in-vehicle driver-moni...

Background: Toll-like receptor (TLR) activation is hypothesized to contribute to inflammatory eye... more Background: Toll-like receptor (TLR) activation is hypothesized to contribute to inflammatory eye disease including uveitis, yet the distribution pattern of TLRs in human uveal tissues remains poorly described. The purpose of this study was to investigate the expression profile of TLRs in human iris pigment epithelial cells (IPE) at the gene and protein level and examine the effect of pathogen-associated molecular patterns (PAMPs), such as Pam 3 CSK 4 .3HCl, Poly(I:C), lipopolysaccharides (LPS from E. coli serotype O111:B4), Flagellin, MALP-2 (macrophage activating lipopeptide-2), Poly(U) and CpGODN2395 on the production of inflammatory mediators including interleukin-8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) from human IPE and retinal pigment epithelial cells (RPE).

British Journal of Ophthalmology, 1999

BACKGROUND/AIMSPterygia are a common disorder of the ocular surface. The disease represents a chr... more BACKGROUND/AIMSPterygia are a common disorder of the ocular surface. The disease represents a chronic fibrovascular and degenerative process thought to originate at the conjunctival-corneal junction, where altered limbal stem cells are proposed to be the cell of origin. Extensive epidemiological evidence exists to implicate ultraviolet B irradiation in the pathogenesis of pterygia. To date no animal or in vitro culture

PURPOSE. Pterygia are a common, benign, fibrovascular, and infiltrative process of the corneal- c... more PURPOSE. Pterygia are a common, benign, fibrovascular, and infiltrative process of the corneal- conjunctival junction of unknown pathogenesis. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes active against all components of the extracellular matrix, whose activity is specifically neutralized by tissue inhibitors of MMPs (TIMPs). In the current study the hypothesis was that MMPs and TIMPs may actively participate

Australian and New Zealand Journal of Ophthalmology, 1990

A series of 17 patients with ocular cicatricial pemphigoid (OCP) is described retrospectively. Th... more A series of 17 patients with ocular cicatricial pemphigoid (OCP) is described retrospectively. The importance of early recognition, especially of disease involving the medial canthus and caruncular region, diagnosis by biopsy, and adequate immunosuppressive and surgical therapy, are emphasised. A detailed grading scheme has been developed and this has enabled the authors to determine the success or failure of the therapy during the active treatment period. A combined ophthalmological and immunological approach to treatment can result in a successful visual outcome of this potentially blinding disease.

Clinical & experimental ophthalmology, Jan 8, 2014

To assess the impact of cataract on quality of life (QoL) for patients with glaucoma. Cross-secti... more To assess the impact of cataract on quality of life (QoL) for patients with glaucoma. Cross-sectional study. Two hundred forty-two patients with mild (n = 67), moderate (n = 80) or severe (n = 45) glaucoma and 50 controls (glaucoma suspects). Patients with cataract of any severity were included. The following data were collected: sociodemographic information, phakic/pseudophakic status, cataract grade according to the Lens Opacities Classification System (LOCS) III, visual acuity and visual field test parameters. Glaucoma severity was stratified according to binocular visual field loss. Visually significant cataract was defined as: LOCS III criteria nuclear cataract ≥3/6.9, cortical cataract ≥3/5.9 or posterior subcapsular cataract ≥2/5.9. Patients' QoL was measured using Rasch-transformed scores from the Glaucoma Activity Limitation-9 (GAL-9) questionnaire. Multiple linear regression models were used to determine the association between cataract and GAL-9 (logit) score. Fifty-s...

Ophthalmology, 1999

To document the clinical features, systemic associations, and visual outcome in a large number of... more To document the clinical features, systemic associations, and visual outcome in a large number of patients with posterior scleritis. Retrospective, noncomparative case series. There were 137 patient records showing patients with a diagnosis of posterior scleritis who were attending or had attended the scleritis clinic at Moorfields Eye Hospital between 1974 and 1996. Ninety-nine records were suitable for detailed analysis. The medical records and B-mode ultrasound examinations were reviewed. The clinical features, systemic associations, treatment, and outcome of each patient were determined. Posterior scleritis occurred at all ages. The mean age at onset was 49.3 years. Posterior scleritis began before age 40 in 30% of patients and was twice as common in women as in men. The B-mode ultrasound examination showed diffuse and nodular changes in the posterior sclera. Necrotizing posterior scleritis was not identified. Twenty-nine percent of patients had an associated systemic disease that included systemic vasculidites, autoimmune diseases, and lymphoma. Such patients more commonly had nodular changes on B-mode ultrasound examination. Early treatment controlled posterior scleral inflammation and limited visual loss. Thirty-one percent of patients lost two or more lines of vision. Statistical analysis revealed that patients older than age 50 had an increased risk of having an associated systemic disease and were more likely to experience visual loss. Patients with associated systemic disease required more aggressive immunosuppressive therapy and more frequently had accompanying anterior scleritis. There was no association between unilateral, bilateral, or recurrent disease and the presence of systemic disease or visual loss from posterior scleritis. The B-mode ultrasound examination reveals that posterior scleritis occurs far more often than previously thought and can lead to rapid and permanent visual loss. All patients with posterior scleritis must be assumed to be at risk of visual loss. Forty percent of patients had no anterior scleral inflammation, and 9% had no detectable physical signs. All patients need to be investigated for an associated systemic disease and all require early treatment to minimize loss of vision.

Ophthalmology, 2004

To report the use of methotrexate therapy as first-line systemic therapy in the treatment of ocul... more To report the use of methotrexate therapy as first-line systemic therapy in the treatment of ocular-cicatricial pemphigoid and drug-induced ocular-cicatricial pemphigoid. Retrospective, noncomparative, interventional case series. Twelve patients with ocular-cicatricial pemphigoid and 5 patients with drug-induced ocular-cicatricial pemphigoid treated with low-dose oral methotrexate as the sole systemic agent. In 14 of the 17 patients, methotrexate was the first systemic agent used. Clinical data abstracted from patient medical records. Visual acuity, conjunctival inflammation, progression of cicatrization, and treatment-related side effects. After a mean follow-up duration of 30.2 months (range, 6-78 months), complete control or suppression, or both, of conjunctival inflammation was achieved in 89% of eyes with ocular-cicatricial pemphigoid and in 100% of eyes with drug-induced ocular-cicatricial pemphigoid using methotrexate monotherapy as the first-line systemic agent. Progression ...

Survey of Ophthalmology, 2005

Scleritis is typically a severe painful inflammatory process centered in the sclera that may invo... more Scleritis is typically a severe painful inflammatory process centered in the sclera that may involve the cornea, adjacent episclera, and underlying uvea; it poses a significant threat to vision. Careful clinical history taking, detailed ocular examination, appropriate investigation for ocular disease with or without underlying systemic disease, and timely intervention with the use of immunosuppressant drugs when necessary, has improved the long-term outcome for patients with this disease. (Surv Ophthalmol 50:351-363, 2005. Ć 2005 Elsevier Inc. All rights reserved.)

Ophthalmology, 2014

Purpose: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis... more Purpose: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure. Design: Retrospective cohort study. Participants: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia.