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Ocular Inflammation & Immunology

What We Do

The Ocular Inflammation & Immunology Department is led by Professor Chee Soon Phaik. 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.

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