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1. Intraocular solitary extramedullary plasmacytoma presenting as unilateral anterior and intermediate uveitis preceded by refractory glaucoma

Author

Tom Ayton, Svetlana Cherepanoff, David Gottlieb, William A. Sewell, Sandy Smith, and Claire Hooper

Subjects
Solitary Extramedullary Plasmacytoma, Intraocular, Uveitis, Refractory Glaucoma, Ophthalmology, RE1-994
Abstract

Abstract Background Solitary extramedullary plasmacytoma (SEP) is a localised proliferation of monoclonal plasma cells involving soft tissue with no or minimal bone marrow involvement and no other systemic evidence of multiple myeloma. Intraocular involvement is exceedingly rare. Case presentation We report a 78-year-old man who was referred with glaucoma in the right eye. He subsequently developed anterior chamber (AC) inflammation and refractory glaucoma then dense vitritis. A vitrectomy was performed with the biopsy revealing numerous plasma cells with atypical findings. In conjunction with the flow cytometry results, and a systemic work up excluding multiple myeloma, a diagnosis of SEP was made. The patient was treated with ocular external beam radiotherapy with resolution of the intraocular inflammation and control of the intraocular pressure. He remains well with no local recurrence and no development of multiple myeloma over a follow up period of 2.5 years. Conclusions This is the first case report of SEP presenting as intraocular inflammation without a uveal tract mass.

Published
2021
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2. Tolerating Subretinal Fluid in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab Using a Treat-and-Extend Regimen

Author

Robyn H. Guymer, Caroline M. Markey, Ian L. McAllister, Mark C. Gillies, Alex P. Hunyor, Jennifer J. Arnold, Andrew Chang, Adil Syed, Geoffrey Broadhead, Thomas Pham, Thomas Hong, Lily Wong, Meidong Zhu, Shelley Burnett, Nichole Joachim, Wijeyanthy Wijeyakumar, Gabriel Manalang, Cleopatra Mhlanga, Nicole Joachim, Kimperly Spooner, Paul Mitchell, Suriya Foran, Christabel Wilson, Victoria Cossatto, Laskshmi Waniganayke, Vivien Mai, Rabiya Atif, Lakshmi Wa, Sapna Maharaj, David Liong, Christine Matic, Katherine Tran, Sheenal Jas, Danielle Gibbs, Sanj Wickremasinghe, Robyn Guymer, Lyndell Lim, Sukhpal Sandhu, Thanh Nguyen, Dania Qatarneh, Hessom Razavi, Elaine Chong, Matthew Little, Gaurav Bhardwau, Michael Ayres, Michael Chen, Daini Ong, Katarina Creese, Tricia Drew, Carly D'Sylva Parfett, Tanya Pejnovic, Thuy Chau, Sutha Sanmugasundram, Maria Kolic, Elizabeth Glatz, Tina-Marie Tonder, Alan Luckie, Stephen Heery, Timothy Steele, Jennifer Arnold, Bryan Matthews, Julie Croft, Alex Breen, Bronwyn Gabriel, Maegan Anderson, Michelle Dodds, Marcus Dwyer, Bev Brown, Jacinta Dwyer, Ivan Fu, Helen Macauley, James Wong, Rajeev Chalasani, Charmaine Lim, Son Huynh, Timothy Nolan, James Leong, Kit Lau, Swas Kumar, Trang Nguyen, Joseph Bitar, Hannah Ahern, Arooj Ali, Nuria Zamora, Angela Lai, Randa Moussa, Carmen Do, Nitin Verma, Guy Bylsma, Andrew Traill, Beverley Curry, Amy Paprotny, Alfonso Ayesa, Alyse Johns, Zanobia Ujjainwala, Andrew Maver, Derek Chan, John Chang, Hyong Kwon Kang, Gavin Stringfellow, Terence Tan, Helen Cass, Trish Forsyth, Anh Nguyen, Angela Chung, Harriette Ayson, Catherine Severino, Caroline Chahine, Lara Collis, Anita Cristy, Mona Mohmodian, Selina Webb, Muradiya Payir, Mara Garibaldi, Trazia Mekhail, Brendan Vote, Tze'Yo Toh, Nima Pakrou, Jennie Rossetto, Shannon Harris, Rachael Adams, Rachael Groves, Maddie Johns, Kristie Richards, Eliza Jenkins, Natalie Daley, James Baker, Mark Gorbatov, Lavaniya Rajanayagam, Ludmila Jitskaia, Jenny Xie, Anthony Nguyen, Ian McAllister, Fred Chen, Tim Isaacs, Tracey-Anne Dickens, Rachel Matthews, Amelia Jason, Ivy Tang, Gareth Lingham, Holly Brown, Alla Soloshenko, Max Cuypers, Anne McSweeney, Jolly Gilhotra, Shane Durkin, James Muecke, Kerin Haywood, Cathy Brko, Rinty Vincent, Carolyn Luscombe, Alex Hunyor, Christine Younan, Robert Chong, Rohan Merani, Adrian Fung, I-Van Ho, Gerald Liew, Vinnci Lee, Gerald Chan, Sarah Liu, Tharini Ganess, Susanthy Rajasundaran, Maryam Sadat, Godfrey Quin, Stephen Ong, Claire Hooper, Vivien Dihn, Ward Al-Ghurani, Sally Ngai, Maria Choi, Gordana Tisma, Anton Van Heerden, Anthony Hall, Kira Michalova, Natalie Coleman, Allanah Price, Mercy Nguyen, Clodia Hanna, Camille Collins, Elaina Dickeson, Annie Lee, Mela Bilyk, Theresa Lee, John Downie, Naggi Assaad, Leanne Cooper, Catherine Le, Amanda Armanssen, and Zena Khalil

Subjects
medicine.medical_specialty, Visual acuity, genetic structures, Bevacizumab, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Ophthalmology, Medicine, Prospective cohort study, 030304 developmental biology, 0303 health sciences, medicine.diagnostic_test, business.industry, Retrospective cohort study, Macular degeneration, Fluorescein angiography, medicine.disease, 030221 ophthalmology & optometry, medicine.symptom, Ranibizumab, business, medicine.drug
Abstract

Purpose To test the hypothesis that tolerating some subretinal fluid (SRF) in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab using a treat-and-extend (TE intensive arm: SRF intolerant) or resolution of all IRF only (relaxed arm: SRF tolerant except for SRF >200 μm at the foveal center) before extending treatment intervals. A 5-letter noninferiority margin was applied to the primary outcome. Main Outcome Measures Mean change in best-corrected VA (BCVA), and central subfield thickness and number of injections from baseline to month 24. Results Of the 349 participants randomized (intensive arm, n = 174; relaxed arm, n = 175), 279 (79.9%) completed the month 24. The mean change in BCVA from baseline to month 24 was 3.0 letters (standard deviation, 16.3 letters) in the intensive group and 2.6 letters (standard deviation, 16.3 letters) in the relaxed group, demonstrating noninferiority of the relaxed compared with the intensive treatment (P = 0.99). Similar proportions of both groups achieved 20/40 or better VA (53.5% and 56.6%, respectively; P = 0.92) and 20/200 or worse VA (8.7% and 8.1%, respectively; P = 0.52). Participants in the relaxed group received fewer ranibizumab injections over 24 months (mean, 15.8 [standard deviation, 5.9]) than those in the intensive group (mean, 17 [standard deviation, 6.5]; P = 0.001). Significantly more participants in the intensive group never extended beyond 4-week treatment intervals (13.5%) than in the relaxed group (2.8%; P = 0.003), and significantly more participants in the relaxed group extended to and maintained 12-week treatment intervals (29.6%) than the intensive group (15.0%; P = 0.005). Conclusions Patients treated with a ranibizumab T&E protocol who tolerated some SRF achieved VA that is comparable, with fewer injections, with that achieved when treatment aimed to resolve all SRF completely.

Published
2019

4. Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Author

Dick, Andrew D., Fmedsci, FRCOphth Correspondence information about the author FMedSci, Dick†, FRCOphth Andrew D., Email the author FMedSci, Dick, FRCOphth Andrew D., Rosenbaum, James T., MD†, Al-Dhibi, Hassan A., Rubens Belfort, Jr., Phd, Md, Brézin, Antoine P., Soon Phaik Chee, Frcophth, Frcs, Davis, Janet L., Md, Ma, Ramanan, Athimalaipet V., Frcp, Frcpch, Koh-Hei, Sonoda, Ester, Carreño, Heloisa, Nascimento, Sawsen, Salah, Sherveen, Salek, Jay, Siak, Frcophth, FRCSEd(Ophth), Laura, Steeples, Frcophth, MBChB(Hons) Massimo Accorinti, Nisha, Acharya, Alfredo, Adan, Rupesh, Agrawal, Nurullah, Akkoc, Saed Al Ghamdi, Turki Al Ghamdi, Anood Al Saati, Nasser, Alsabaani, Mohamed, Al-Shamarani, Artur, Bachta, Talin, Barisani-Asenbauer, Nicholas, Beare, Fernanda Belga Ottoni Porto, Ricardo, Blanco, Anita Chan Sook Yee, Vinod, Chandran, Christophe, Chiquet, Hiok Hee Chng, Andrius, Cimbalas, Luca, Cimino, Miguel, Cordero-Coma, Couto, Cristobal, Miguel, Cuevas, João Eurico da Fonseca, Joke de Boer, Alejandra de la Torre, Ilse De Schryver, Larissa, Derzko-Dzulynsky, David, Diaz-Valle, Claudia Eugenia Duran Merino, Andrea, Facsko, Luis, Figueira, Alejandro, Fonollosa, Eric, Fortin, Richard, Gale, Mauro, Galeazzi, Sandra, Garcia, Jose Maria Garcia Ruiz de Morales, Nataša, Gašperšič, Debra, Goldstein, Marta, Guedes, Yan, Guex-Crosier, Ahmet, Gul, Rola, Hamam, Muhammad, Haroon, Kenichi, Hasegawa, Arnd, Heiligenhaus, Claire, Hooper, Yih-Shiou, Hwang, De-Kuang, Hwang, Xavier, Juanola, Toshikatsu, Kaburaki, Sibel, Kadayifcilar, John, Kempen, Takeshi, Kezuka, Amin, Kherani, Maarja, Kirsimäe, Kaisu, Kotaniemi, Aleksandra, Kraut, Agnieszka, Kubicka-Trząska, Lucia, Kuffova, Susan, Lightman, Lyndell, Lim, Wee Kiak Lim, Peter, Mccluskey, Mairide, Mcguire, Pierfrancesco, Mirabelli, Elisabetta, Miserocchi, Marta, Misiuk-Hojło, Cristina, Muccioli, Santiago, Muñoz, Conor, Murphy, Murray, Philip I., Zoltan, Nagy, Kenichi, Namba, Piergiorgio, Neri, Quan, Nguyen, Donncha, O'Gradaigh, Mohammed, Omair, Kati, Otsa, Yilmaz, Ozyazgan, Franco, Pablo, Paroli, Maria Pia, Uwe, Pleyer, Gyula, Poór, Rui, Proença, Theodore, Rabinovitch, Russell, Read, Margarita, Rebrov, Claudia, Recillas-Gispert, Aniki, Rothova, Sergio, Schwartzman, Pascal, Seve, Srilakshmi, Sharma, Joanne, Sims, Nicolette, Sohár, Eric, Suhler, Sándor, Szántó, Zsuzsanna, Szepessy, Christoph, Tappeiner, Jennifer, Thorne, Ilknur Tugal Tutkun, Anna, Turno-Kręcicka, Joachim Van Calster, Irene van der Horst-Bruinsma, Nataša Vidovič Valentinčič, Albert, Vitale, Stephanie Voorduin Ramos, Nenad, Vukojevic, Denis, Wakefield, François, Willermain, Nilufer, Yalcindag, Joyce Hisae Yamamoto, Stephen, Yeh, Reda, Zemaitiene, and Olga, Ziouzina

Subjects
biologic agents, immunomodulatory treatment, uveitis
Published
2018

5. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

Author

Andrew D. Dick, James T. Rosenbaum, Hassan A. Al-Dhibi, Rubens Belfort, Antoine P. Brézin, Soon Phaik Chee, Janet L. Davis, Athimalaipet V. Ramanan, Koh-Hei Sonoda, Ester Carreño, Heloisa Nascimento, Sawsen Salah, Sherveen Salek, Jay Siak, Laura Steeples, Massimo Accorinti, Nisha Acharya, Alfredo Adan, Rupesh Agrawal, Nurullah Akkoc, Saed Al Ghamdi, Turki Al Ghamdi, Anood Al Saati, Nasser Alsabaani, Mohamed Al-Shamarani, Artur Bachta, Talin Barisani-Asenbauer, Nicholas Beare, Fernanda Belga Ottoni Porto, Ricardo Blanco, Anita Chan Sook Yee, Vinod Chandran, Christophe Chiquet, Hiok Hee Chng, Andrius Cimbalas, Luca Cimino, Miguel Cordero-Coma, Couto Cristobal, Miguel Cuevas, João Eurico da Fonseca, Joke de Boer, Alejandra de la Torre, Ilse De Schryver, Larissa Derzko-Dzulynsky, David Diaz-Valle, Claudia Eugenia Duran Merino, Andrea Facsko, Luis Figueira, Alejandro Fonollosa, Eric Fortin, Richard Gale, Mauro Galeazzi, Sandra Garcia, Jose Maria Garcia Ruiz de Morales, Nataša Gašperšič, Debra Goldstein, Marta Guedes, Yan Guex-Crosier, Ahmet Gul, Rola Hamam, Muhammad Haroon, Kenichi Hasegawa, Arnd Heiligenhaus, Claire Hooper, Yih-Shiou Hwang, De-Kuang Hwang, Xavier Juanola, Toshikatsu Kaburaki, Sibel Kadayifcilar, John Kempen, Takeshi Kezuka, Amin Kherani, Maarja Kirsimäe, Kaisu Kotaniemi, Aleksandra Kraut, Agnieszka Kubicka-Trząska, Lucia Kuffova, Susan Lightman, Lyndell Lim, Wee Kiak Lim, Peter McCluskey, Mairide McGuire, Pierfrancesco Mirabelli, Elisabetta Miserocchi, Marta Misiuk-Hojło, Cristina Muccioli, Santiago Muñoz, Conor Murphy, Philip I. Murray, Zoltan Nagy, Kenichi Namba, Piergiorgio Neri, Quan Nguyen, Donncha O'Gradaigh, Mohammed Omair, Kati Otsa, Yilmaz Ozyazgan, Franco Pablo, Maria Pia Paroli, Uwe Pleyer, Gyula Poór, Rui Proença, Theodore Rabinovitch, Russell Read, Margarita Rebrov, Claudia Recillas-Gispert, Aniki Rothova, Sergio Schwartzman, Pascal Seve, Srilakshmi Sharma, Joanne Sims, Nicolette Sohár, Eric Suhler, Sándor Szántó, Zsuzsanna Szepessy, Christoph Tappeiner, Jennifer Thorne, Ilknur Tugal Tutkun, Anna Turno-Kręcicka, Joachim Van Calster, Irene van der Horst-Bruinsma, Nataša Vidovič Valentinčič, Albert Vitale, Stephanie Voorduin Ramos, Nenad Vukojevic, Denis Wakefield, François Willermain, Nilufer Yalcindag, Joyce Hisae Yamamoto, Stephen Yeh, Reda Zemaitiene, and Olga Ziouzina

Subjects
030203 arthritis & rheumatology, medicine.medical_specialty, business.industry, MEDLINE, Retrospective cohort study, noninfectious uveitis, noncorticosteroid systemic immunomodulatory agents, Treatment consensus, Evidence-based medicine, CINAHL, Cochrane Library, medicine.disease, law.invention, 03 medical and health sciences, Ophthalmology, 0302 clinical medicine, Systematic review, Randomized controlled trial, law, Family medicine, 030221 ophthalmology & optometry, Medicine, business, Uveitis
Abstract

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016 ; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents ; what data to collect before treatment ; when to modify or withdraw treatment ; how to select agents based on individual efficacy and safety profiles ; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.

Published
2018

6. MANAGEMENT OF SUBMACULAR HEMORRHAGE WITH INTRAVITREAL INJECTION OF TISSUE PLASMINOGEN ACTIVATOR AND EXPANSILE GAS

Author

Matthew Chamberlain, Daniel Chiu, Christine Y. Chen, Wilson J. Heriot, Claire Hooper, and Niral Karia

Subjects
Adult, Male, medicine.medical_specialty, Visual acuity, genetic structures, Sulfur Hexafluoride, Visual Acuity, Physical examination, Tissue plasminogen activator, Injections, Fibrinolytic Agents, Ophthalmology, medicine, Humans, Intraoperative Complications, Aged, Retrospective Studies, Aged, 80 and over, Fluorocarbons, medicine.diagnostic_test, business.industry, Retinal Hemorrhage, Retinal detachment, Retrospective cohort study, General Medicine, Middle Aged, Macular degeneration, medicine.disease, eye diseases, Vitreous Body, Treatment Outcome, Tissue Plasminogen Activator, Vitreous hemorrhage, Drug Therapy, Combination, Female, medicine.symptom, business, Fibrinolytic agent, medicine.drug
Abstract

Purpose To evaluate the clinical outcome of intravitreal tissue plasminogen activator (tPA) and expansile gas injection as a minimally invasive treatment for submacular hemorrhage (SMH). Methods This study was a retrospective clinical case series examining 104 eyes that received an intravitreal injection of 30-100 mcg of tPA and expansile gas (SF6 or C3F8) for SMH. The main outcomes evaluated were visual acuities (VA), anatomic displacement of submacular blood, and surgical complications. Results : A total of 85, 77, and 81 eyes were available at 1 week, 3 months, and 12 months follow up, respectively. Postoperatively, > or = 2 Snellen lines improvement were achieved in 43/85 eyes (51%) at 1 week, 49/77 eyes (63%) at 3 months, and 52/81 eyes (64%) at 12 months. Postoperative VA improvement was significantly associated with preoperative VA, submacular blood displacement, and the underlying cause of SMH. Diagnostic postoperative angiogram and clinical examination were possible at 8.2 +/- 7.4 weeks and 9.5 +/- 7.4 weeks, respectively. The observed complications included breakthrough vitreous hemorrhage in 8 eyes (8%) and retinal detachment in 3 eyes (3%). Conclusions In this retrospective series, intravitreal injection of tPA and expansile gas was shown to be a safe and effective technique that can improve VA in most eyes with SMH and assist in the diagnosis of the underlying cause.

Published
2007

7. Development of an Alcohol Withdrawal Clinical Pathway: An Interdisciplinary Process

Author

Nancy Honz, Anna Rodriguez-Garcia, Claire Hooper, and Sarah R. Zacharias

Subjects
Patient Care Team, medicine.medical_specialty, Colorado, Patient care team, Critical pathways, business.industry, Process (engineering), Alcoholic Beverages, MEDLINE, Nursing assessment, Hospitals, General, Substance Withdrawal Syndrome, Alcoholism, Clinical pathway, Acute care, Critical Pathways, Humans, Medicine, business, Intensive care medicine, Social psychology, Nursing Assessment, General Nursing
Abstract

Studies show that as many as 40 percent of all patients in general hospitals are admitted because of complications related to alcoholism. However, the literature has little in specific clinical pathways, treatment protocols, or guidelines for the interdisciplinary care of these patients in the acute care setting. Furthermore, the little information that is published shows a lack of consistency in recommended treatment regimes. This article reviews a coordinated, interdisciplinary effort in developing and implementing a clinical pathway for alcohol withdrawal.

Published
1998

9. A chip off the new technology block

Author

Claire Hooper

Subjects
Multidisciplinary, Computer science, business.industry, Block (telecommunications), System on a chip, Chip, business, Computer hardware
Published
1989

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