CLINICAL SERVICES - OCULAR INFLAMMATION & IMMUNOLOGY

OUR CLINICAL SERVICES : WHAT WE DO

The Ocular Inflammation and Immunology Service is a tertiary service that receives referrals from local and regional ophthalmologists. The service sees about 5,000 clinical attendances annually. Our uveitis clinic sees an average of 250 attendances per week. Since the set up of our uveitis service in 1994, we have established a database of 1,493 patients. This database aids our specialists in tracking and analysing the prevalence of various forms of uveitis in our population.

Swollen optic nerve	Corneal oedema	Retinal vasculitis
Scleritis	Retinal necrosis	Hypopyon

SNEC deals with a wide range of ocular inflammatory conditions – some of which result in significant ocular morbidity and are estimated to account for 5 to 15% of blindness. Common ocular inflammations seen at our service include:

• HLA-B27 related anterior uveitis
• Fuch's heterochromic iridocyclitis
• Posner schlossman syndrome
• Intermediate uveitis
• Behcet's disease
• Vogt-Koyanagi-Harada syndrome
• Ocular infections such as acute and chronic endophthalmitis
• Toxoplasmosis chorioretinitis
• Tuberculosis uveitis
• Ocular malignancies such as ocular lymphoma

Chorioretinitis	PCR lab setup	Cytology
X-ray sacroiliitis	Gel electrophoresis

Our service also provides advanced diagnostic and therapeutic options including:

• Angiography including fluorescein and indocyanine green
• Optical coherence tomography
• Ultrasonography B-scan
• Ultrasound biomicroscopy
• Polymerase chain reaction (PCR) for microbes
• HLA phenotyping
• Radiological investigations
• A wide range of blood biochemistry, immunology and serology investigations
• Microbiology investigations for urgent diagnosis in severe infective cases such as endophthalmitis.
• Cytokine assays

With polymerase chain reaction (PCR), our ophthalmologists are able to aspirate as little as a drop (0.1ml) of aqueous humour from the eye and use it to detect the presence of viral and fungal DNA. In 2008 alone, 150 samples were sent to the molecular laboratory for analysis for infective DNA particles.

As a result of these investigations, we discovered an underlying more generalised condition in 37% of patients that was previously unrecognised. Amongst this group of patients, the underlying diagnosis includes:

• Tuberculosis
• Ankylosing spondylitis
• Behcet’s disease
• Rheumatoid arthritis
• Sarcoidosis
• Syphilis
• Systemic lupus erythematous
• Wegener’s granulomatosis

Rare but serious conditions such as HIV infection and previously undetected cancer have also been discovered as a result of investigation of the eye inflammation. To ensure holistic care, our department works closely with colleagues in infectious disease and rheumatology to ensure our patients receive all-around care.

In addition we have the facilities and expertise in using some of the technologies in imaging ocular structures including:

• Optical coherence tomography
• Ultrasound biomicroscopy
• Confocal microscopy
• Fluorescein and Indocyanine green angiography

Maculopathy (Fluorescein angiography)	Fluorescein angiography study

Treatment

Treatment for uveitis is often prolonged. For sight threatening cases we may need to employ very strong medications such as anti-cancer drugs that suppress our immune system (immunosuppressants). Use of these medications requires careful monitoring to make sure our patients are receiving the appropriate dose whilst not suffering from any serious side effects. Currently 37% of our patients are receiving oral medications. Our department has doctors who are trained in administering these medications, and nursing staff who counsel and communicate closely with patients should they have urgent queries.

Surgery

Severe and prolonged ocular inflammation may cause complications in the eye, such as secondary cataract and glaucoma. Surgery may be necessary in such cases. Dealing with these complicated cases requires expertise and experience, both in controlling the overall inflammation status and in surgical technique. Over the years we have successfully managed many patients with uveitis who required surgery including cataract extraction, glaucoma surgery and retinal surgery.

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Ocular Inflammation and Immunology Clinical Staff
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Ocular Inflammation and Immunology