What We Do

The Ocular Inflammation & Immunology Department is led by Dr Anita Chan (Head and Senior Consultant). It is a tertiary department that receives referrals from local and regional ophthalmologists.

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%-15% of blindness. Common ocular inflammations seen at our department 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

Our department also provides advanced diagnostic and therapeutic options including:

Angiography including fluorescein and indocyanine green
Optical coherence tomography and Optical coherence tomography – Angiography
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 (0.2ml) 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. Among 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 and Angiography
Ultrasound biomicroscopy
Confocal microscopy
Fluorescein and Indocyanine green angiograph

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.

Tag: Ocular Inflammation & Immunology