Shao EH, Tempest-Roe S, Taylor SR (2015) Increases in markers of renal damage in patients with diabetic maculopathy receiving intravitreal Avastin,
Taylor SR, Singh J, Sagoo MS, Lightman SL (2012) Clinical and molecular features associated with cystic visceral lesions in von hippel-lindau disease., The open ophthalmology journal6pp. 83-85
Von Hippel-Lindau (VHL) is an uncommon oncogenic disorder which occurs as a result of genetic mutations on chromosome 3p. Retinal capillary haemangiomas and CNS haemangioblastomas have been well-characterised in genotypic-phenotypic analyses, but cystic visceral lesions are less common and have been less frequently studied. The aim of this study was to perform genotypic and phenotypic analysis of a cohort of VHL patients that developed cystic visceral lesions to determine whether their genotype differs from that seen in other manifestations of VHL and whether the ocular manifestations differ.This study reports a prospective case series of twenty-one patients identified from the Hammersmith Hospital Genetics Service database as having VHL mutations. Patients underwent regular ocular and systemic screening as well as genotypic analysis. The main outcome measures were the development of VHL lesions, either ocular or systemic.Cystic visceral lesions were detected in six of the 21 patients from the clinic (29%). These included renal cysts in four patients, pancreatic cysts in three patients, and an epididymal cystadenoma in one patient. Renal cysts were not associated with any specific genotype. Pancreatic cysts appeared to occur in association with VHL gene deletions and all developed CNS haemangioblastomas. Only one patient developed ocular manifestations, which occurred in this patient in the form of two retinal capillary haemangiomas.VHL gene deletions appeared to be associated with pancreatic cysts and the development of CNS haemangioblastomas. Ocular manifestations are uncommon in this group of patients.
Talat L, Tomkins-Netzer O, Taylor SRJ, Din NM, Bar A, Isa H, Lightman S (2014) The influence of diabetes mellitus on the management and visual outcome of patients with uveitis, ACTA OPHTHALMOLOGICA92(4)pp. e329-e330 WILEY-BLACKWELL
Taylor SRJ (2010) Ocular Syphilis, Royal College of Ophthalmologists
Syphilis is still an important cause of eye disease and blindness in the Western world and is being diagnosed with increasing frequency in patients with HIV/AIDS. It is known as the 'great imitator' and can present to ophthalmologists with myriad symptoms and signs. Diagnosis is based on clinical examination and serological testing. The mainstay of treatment remains penicillin, but care needs to be taken that the treatment given is adequate for neurosyphilis.
Manasseh GSL, Shao EH, Taylor SRJ (2015) Treatment of diabetic maculopathy, BRITISH JOURNAL OF HOSPITAL MEDICINE76(1)pp. 35-40 MA HEALTHCARE LTD
Joshi L, Lightman S, Taylor SRJ (2011) Ocular vascular involvement in the rheumatic diseases, Current Rheumatology Reviews7pp. 39-50
Taylor SRJ, Banker A, Schlaen A, Couto C, Matthe E, Joshi L, Menezo V, Ethan N, Tomkins-Netzer O, Bar A, Morarji J, Mccluskey P, Lightman S (2013) INTRAOCULAR METHOTREXATE CAN INDUCE EXTENDED REMISSION IN SOME PATIENTS IN NONINFECTIOUS UVEITIS, RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES33(10)pp. 2149-2154 LIPPINCOTT WILLIAMS & WILKINS
Taylor SRJ The P2X7 receptor in immune cells,
The P2X7 receptor is a cation channel activated by high concentrations of ATP. Its stimulation is pro-inflammatory, with activation resulting in the release of cytokines (notably IL-1²), changes in plasma membrane lipid distribution, and cell death. A central role for P2X7 in IL-1² secretion via the NALP3 inflammasome has been confirmed in gene-deficient mice generated by GlaxoSmithKline (GSK) and Pfizer. It is abundantly expressed on cells of the immune system and may play a role in the pathogenesis of autoimmune disease, notable systemic lupus erythematosus (SLE). Indeed, P2X7 has become an important potential therapeutic target, and antagonists are currently in Phase II clinical trials for treatment of rheumatoid arthritis and chronic obstructive pulmonary disease. In this thesis, I describe my investigation into the role of the P2X7 receptor in immune function, examining in detail the responses of murine T cells, macrophages and dendritic cells to P2X7 stimulation. Investigation of T cell responses reveals a novel form of cell death in which cells initially shrink and then swell, before undergoing catastrophic lysis with release of cellular contents into the surrounding milieu, a process which I have termed aponecrosis as it bears features of both apoptosis and necrosis. In addition, I report a detailed characterisation of immune cells from the GSK P2X7-/- mouse. Functional and mRNA data demonstrate tissue-specific ?leakiness?, such that P2X7 expression is ablated in P2X7-/- macrophages, but not in P2X7-/- T cells. This explains previous paradoxical experimental and immunohistochemical data achieved with P2X7-/- mice without the need to invoke the expression of an additional P2X7-like protein cross-reactive with P2X7 antibodies. Finally, I report the use of a mouse model of antibody-mediated glomerulonephritis to demonstrate that P2X7 plays a key pro-inflammatory role in immune-mediated injury and that this receptor is a possible therapeutic target in vivo.
Taylor SR, Gurbaxani A, Sallam A, Lightman S (2012) Topical prostaglandin analogues and conjunctival inflammation in uveitic glaucoma., The open ophthalmology journal6pp. 75-78
A pilot study to determine whether topical prostaglandin analogues alter the expression of conjunctival inflammatory markers in patients with uveitic glaucoma.Prospective, single-masked case series of 20 patients with uveitis and secondary raised intraocular pressure. Participants were divided into four groups of five patients dependent on their use of topical medication: (1) prostaglandin analogues only, (2) corticosteroids only, (3) both prostaglandin analogues and corticosteroids, (4) no topical medication. Conjunctival cells were harvested by impression cytology and were examined for inflammatory markers (CD3, CD54, HLA-DR, CCR4, CCR5) by flow cytometry. A tear fluid sample was also examined for inflammatory cytokines (IL-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IFN-gamma, IL-1beta, IFN-alpha, IFN-beta) by multiplex bead arrays.All groups demonstrated increased markers of conjunctival inflammation. There was no significant difference in levels of any inflammatory markers between the four groups, suggesting that the use of topical prostaglandin analogues does not increase conjunctival levels of inflammation beyond those already seen in uveitis.The use of topical prostaglandins does not appear to induce conjunctival inflammation over that which is already present in patients with uveitic glaucoma. This supports the use of topical prostaglandin analogues in patients with uveitic glaucoma, indicating that their use is unlikely to adversely affect subsequent glaucoma filtration surgery through the induction of chronic conjunctival inflammation.
Tomkins-Netzer O, Taylor SRJ, Bar A, Lula A, Yaganti S, Talat L, Lightman S (2014) Treatment with Repeat Dexamethasone Implants Results in Long-Term Disease Control in Eyes with Noninfectious Uveitis, OPHTHALMOLOGY121(8)pp. 1649-1654 ELSEVIER SCIENCE INC
Idiopathic orbital inflammatory disease (IOID) is an idiopathic inflammatory process within the orbit that can result in permanent visual impairment. Although high-dose oral corticosteroids are currently the mainstay of therapy, their long-term usage can cause significant toxicity. We present a case of IOID that was successfully treated with the anti-CD20 monoclonal antibody rituximab following failed steroid sparing with conventional second-line immunosuppressive agents.
Tan LT, McNab A, Lightman S, Taylor SRJ (2011) Orbital involvement in the rheumatic diseases, Current Rheumatology Reviews7pp. 51-60
Joshi L, Tomkins-Netzer O, Menezo V, Sallam A, Kirkpatrick N, Lightman S, Taylor SRJ (2013) Dexamethasone implants and neovascular glaucoma in central retinal vein occlusion, Acta Ophthalmologica91(3)pp. e239-e240
Tempest-Roe S, Tam FW, Taylor SRJ (2013) The duration of LPS priming determines the phenotype of macrophage, but not T cell P2X7 responses, Immunology
Tan P, Taylor SRJ, Lightman S (2011) Ocular effects of drugs used in the rheumatic diseases, Current Rheumatology Reviews7pp. 61-73
Liolios V, Joshi L, Menezo V, McLoone E, Lightman S, Taylor SRJ (2013) Dexamethasone intravitreal implant in paediatric non-infectious intermediate and posterior uveitis,
Taylor SRJ, McCluskey P, Lightman S (2006) The ocular manifestations of inflammatory bowel disease, CURRENT OPINION IN OPHTHALMOLOGY17(6)pp. 538-544 LIPPINCOTT WILLIAMS & WILKINS
Goni FJ, Stalmans I, Denis P, Nordmann JP, Taylor SRJ, Diestelhorst M, Figueiredo AR, Garway-Heath DF (2016) Elevated Intraocular Pressure After Intravitreal Steroid Injection in Diabetic Macular Edema: Monitoring and Management, Ophthalmology and Therapy Springer
Introduction: With the increasing use of intravitreal administration of corticosteroids in macular edema, steroid-induced intraocular
pressure (IOP) rise is becoming an emergent issue. However, for patients in whom intravitreal steroids are indicated, there are no specific recommendations for IOP monitoring and management after intravitreal administration of corticosteroids.
Method: An expert panel of European ophthalmologists reviewed evidence on corticosteroid-induced IOP elevation. The objective of the panel was to propose an algorithm based on available literature and their own experience for the monitoring and management of corticosteroid-induced IOP elevation, with a focus on diabetic patients.
Results: Data from trials including diabetic patients with a rise of IOP after intravitreal steroid administration indicate that IOP-lowering medical treatment is sufficient for a large majority of patients; only a small percentage underwent laser trabeculoplasty or filtering filtration surgery. A 2-step algorithm is proposed that is based on the basal value of IOP and evidence for glaucoma. The first step is a
risk stratification before treatment. Patients normotensive at baseline (IOP B 21 mmHg), do not require additional baseline diagnostic tests.
However, patients with baseline ocular hypertension (OHT) (IOP[21 mmHg) should undergo baseline imaging and visual field
testing. The second step describes monitoring and treatment after steroid administration. During follow-up, patients developing OHT should have baseline and periodical imaging and visual field testing; IOP-lowering treatment is proposed only if IOP is [25 mmHg or if diagnostic tests suggest developing glaucoma. Conclusion: The management and follow-up of OHT following intravitreal corticosteroid
injection is similar to that of primary OHT. If OHT develops, IOP is controlled in a large proportion of patients with standard IOP
treatments. The present algorithm was developed to assist ophthalmologists with guiding principles in the management of corticosteroid-induced IOP elevation.
Taylor SRJ, Gonzalez-Begne M, Dewhurst S, Chimini G, Higgins CF, Melvin JE, Elliott JI (2008) Sequential shrinkage and swelling underlie P2X(7)-stimulated lymphocyte phosphatidylserine exposure and death, JOURNAL OF IMMUNOLOGY180(1)pp. 300-308 AMER ASSOC IMMUNOLOGISTS
Tan LT, Isa H, Din NM, Tomkins O, Taylor SRJ, Rose G, Pusey CD, Verity D, Lightman S, Luthert P Orbital manifestations of granulomatosis with polyangiitis: Clinical, imaging and histological features,
Taylor SR, Lightman SL (2012) Curbside Consultation in Uveitis, In: Foster S (eds.), Curbside Consultation in Uveitis Slack
Images, diagrams, and references are included to enhance the text and to illustrate clinical diagnoses and treatment plans.
Taylor S, Lightman S (2005) Visual impairment in the elderly, BRITISH JOURNAL OF HOSPITAL MEDICINE66(12)pp. 662-663 MA HEALTHCARE LTD
Sallam A, Taylor S (2009) Ocular emergencies 1: traumatic, BRITISH JOURNAL OF HOSPITAL MEDICINE70(3)pp. M36-M37 MA HEALTHCARE LTD
Joshi L, Taylor SRJ, Lightman S (2011) The eye and phacomatoses, BRITISH JOURNAL OF HOSPITAL MEDICINE72(12)pp. 677-681 MA HEALTHCARE LTD
Isa H (2015) Predictors of Disease Extension and Progression in Patients with Granulomatosis with Polyangiitis (GPA).,
Taylor SR, Singh J, Sagoo MS, Lightman SL (2012) Clinical and molecular features associated with cystic visceral lesions in von hippel-lindau disease., Open Ophthalmol J6pp. 83-85
BACKGROUND: Von Hippel-Lindau (VHL) is an uncommon oncogenic disorder which occurs as a result of genetic mutations on chromosome 3p. Retinal capillary haemangiomas and CNS haemangioblastomas have been well-characterised in genotypic-phenotypic analyses, but cystic visceral lesions are less common and have been less frequently studied. The aim of this study was to perform genotypic and phenotypic analysis of a cohort of VHL patients that developed cystic visceral lesions to determine whether their genotype differs from that seen in other manifestations of VHL and whether the ocular manifestations differ. METHODS: This study reports a prospective case series of twenty-one patients identified from the Hammersmith Hospital Genetics Service database as having VHL mutations. Patients underwent regular ocular and systemic screening as well as genotypic analysis. The main outcome measures were the development of VHL lesions, either ocular or systemic. RESULTS: Cystic visceral lesions were detected in six of the 21 patients from the clinic (29%). These included renal cysts in four patients, pancreatic cysts in three patients, and an epididymal cystadenoma in one patient. Renal cysts were not associated with any specific genotype. Pancreatic cysts appeared to occur in association with VHL gene deletions and all developed CNS haemangioblastomas. Only one patient developed ocular manifestations, which occurred in this patient in the form of two retinal capillary haemangiomas. CONCLUSIONS: VHL gene deletions appeared to be associated with pancreatic cysts and the development of CNS haemangioblastomas. Ocular manifestations are uncommon in this group of patients.
Taylor SRJ, Church J, Aggarwal R (2005) The 1CU Intraocular Accommodative Lens: Experience of 50 cases,
Jameel AA, Nouraeinejad A, Yang DS, Jeffs N, Galatowicz G, Calder V, Taylor SRJ, Lightman S (2011) The immunoregulatory effects of interferon-alpha therapy on T-cell responsiveness in ocular Behcet's disease,
Md Din S, Isa H, Lightman S, Taylor SRJ (2012) Retinal nerve fibre layer thickness changes in raised Intraocular pressure in uveitis,
Tomkins-Netzer O, Talat L, Bar A, Lula A, Taylor SRJ, Joshi L, Lightman S (2014) Long-Term Clinical Outcome and Causes of Vision Loss in Patients with Uveitis, OPHTHALMOLOGY121(12)pp. 2387-2392 ELSEVIER SCIENCE INC
Sen HN, Drye LT, Goldstein DA, Larson TA, Merrill PT, Pavan PR, Sheppard JD, Burke A, Srivastava SK, Jabs DA (2012) Hypotony in Patients with Uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial, Ocular Immunology and Inflammation20(2)pp. 104-112
Din NM (2014) Elevated intraocular pressure in uveitis: effects on the retinal nerve fiber layer, clinical course and surgical outcome in adults and children,
Pacheco PA, Taylor SRJ, Miguel CT, Gonzalo DV (2008) Azathioprine in the management of autoimmune uveitis, OCULAR IMMUNOLOGY AND INFLAMMATION16(4)pp. 161-165 INFORMA HEALTHCARE
Tan LT, Isa H, Lightman S, Taylor SRJ (2012) Prevalence and causes of phthisis bulbi in a uveitis clinic, ACTA OPHTHALMOLOGICA90(5)pp. e417-e418 WILEY-BLACKWELL
Joshi L, Shirodkhar A, Taylor SRJ, Lightman S (2011) A novel integration of an ophthalmoscopy teaching mdel with simulated patients - its role in providing contextual feedback,
Shirodkhar A, Lightman S, Taylor SRJ (2012) Retinal vein occlusions in uveitis,
Lau CH, Taylor SRJ, Lightman S (2003) The eye in malignant disease, British Journal of Hospital Medicine3(64)pp. 177-179
Taylor SRJ, Salama AD, Joshi L, Pusey CD, Lightman SL (2009) Rituximab Is Effective in the Treatment of Refractory Ophthalmic Wegener's Granulomatosis, ARTHRITIS AND RHEUMATISM60(5)pp. 1540-1547 WILEY-LISS
Taylor SR, Tomkins-Netzer O, Lightman SL (2012) New Treatments in Noninfectious Uveitis, In: Modorati G, Foster CS (eds.), New Treatments in Noninfectious Uveitis
Miserocchi E, Pontikaki I, Modorati G, et al: Rituximab for uveitis. Ophthalmology 2011;118: 223?224. Miserocchi E, Pontikaki I, Modorati G, et al: AntiCD20 monoclonal antibody (rituximab) treatment for inflammatory ocular diseases.
Taylor SRJ, Tomkins-Netzer O, Joshi L, Morarji J, McLoone E, Lightman S (2012) Dexamethasone Implant in Pediatric Uveitis, OPHTHALMOLOGY119(11)pp. 2412-+ ELSEVIER SCIENCE INC
Hooper CY, Lightman SL, Pacheco P, Tam PM, Khan A, Taylor SR (2012) Adjunctive antibiotics in the treatment of acute bacterial endophthalmitis following cataract surgery., Acta Ophthalmol90(7)pp. e572-e573
Kabasele P (2011) Causes of visual loss in patients with uveitis,
Taylor SRJ, Gonzalez-Begne M, Sojka DK, Richardson JC, Sheardown SA, Harrison SM, Pusey CD, Tam FWK, Elliott JI (2009) Lymphocytes from P2X(7)-deficient mice exhibit enhanced P2X(7) responses, JOURNAL OF LEUKOCYTE BIOLOGY85(6)pp. 978-986 FEDERATION AMER SOC EXP BIOL
Joshi L (2011) Evaluating Novel and Established Therapies for Uveitis,
Frick KD, Drye LT, Kempen JH, Dunn JP, Holland GN, Latkany P, Rao NA, Sen HN, Sugar EA, Thorne JE, Wang RC, Holbrook JT (2012) Associations among Visual Acuity and Vision- and Health-Related Quality of Life among Patients in the Multicenter Uveitis Steroid Treatment Trial, Investigative Opthalmology & Visual Science53(3)pp. 1169-1169
Harris F, Chalkiadakis S, Taylor SRJ (2016) The role of inflammation in the pathophysiology of DMO, Eye NewsFeb/Mar2016pp. 19-23
Diabetic macular oedema (DMO) is a major cause of visual loss in diabetes, with a complex multifactorial pathogenesis. In the UK
alone it is estimated that there are nearly 2.5 million diabetic patients aged over 12 years. Approximately 65,000 of these have clinically significant DMO that affects their visual acuity in at least one eye . In DMO, the final common pathway is disruption of the blood-retinal
barrier (BRB), resulting in leakage of fluid into the retinal layers, but causation is complicated, with many factors
contributing to the process. Nevertheless, evidence is mounting that inflammation is implicated in BRB breakdown, together
with hypoxia, alterations in blood flow and retinal ischaemia.
Md Din S, Isa H, Taylor SRJ, Barton K, Lightman S (2012) Raised intraocular pressure in uveitis, Expert Review of Ophthalmology1(7)pp. 45-59
Taylor S, Yang D, Galatowicz G, Nouraeinejad A, Calder V, Lightman S (2010) IMMUNOMODULATORY MECHANISMS INDUCED BY IFN ALPHA 2B, CLINICAL AND EXPERIMENTAL RHEUMATOLOGY28(4)pp. S128-S128 CLINICAL & EXPER RHEUMATOLOGY
Bar A, Tomkins-Netzer O, Taylor SRJ, Lightman S (2012) Visual outcomes in uveitis,
Taylor SRJ, Lightman S (2008) When and how to use periocular and intraocular corticosteroid injections, American Academy of Ophthalmology Current Insight
Taylor SRJ, Lightman S (2011) Hot Topic: The Eye in Rheumatological Disease, Current Rheumatology Reviews(1)pp. 2-2
Taylor SRJ, Salama AD, Joshi L, Pusey CD, Lightman SL (2009) Rituximab Is Effective in the Treatment of Refractory Ophthalmic Wegener's Granulomatosis, ARTHRITIS AND RHEUMATISM60(5)pp. 1540-1547 WILEY-LISS
Joshi L, Tanna A, McAdoo SP, Medjeral-Thomas N, Taylor SRJ, Sandhu G, Tarzi RM, Pusey CD, Lightman S (2015) Long-term Outcomes of Rituximab Therapy in Ocular Granulomatosis with Polyangiitis Impact on Localized and Nonlocalized Disease, OPHTHALMOLOGY122(6)pp. 1262-1268 ELSEVIER SCIENCE INC
Menezo V, Taylor SRJ (2016) Choroidopathy Punctate Inner, In: Kohnen T, Schmidt-Erfurth U (eds.), Encyclopedia of Ophthalmology Springer Berlin Heidelberg
Punctate inner choroidopathy is an uncommon posterior multifocal chorioretinopathy first
described by Watzke et al. (1984). It is character ized by the presence of small, focal, yellow
lesions at the posterior pole occurring at the level of the inner choroid/retinal pigment epithelium in the absence of vitreous inflammation. It usually affects young, myopic females (who may also be fair haired with blue- or light-colored irides). The usual presenting symptoms include blurred vision, scotomata, and/or photopsia.
These usually occur due secondary to inflammatory foci at the time of presentation, but can be
caused by choroidal neovascularization (CNV) complicating the inflammatory focus or by scarring consequent to the inflammation. Despite having such a distinct clinical phenotype, there remains some controversy as to
whether this disease simply represents part of a larger spectrum of chorioretinal disorders of unknown origin, including idiopathic multifocal choroiditis (MFC), the white dot syndrome (WDS) spectrum, and idiopathic or myopia-associated CNV formation.
Although the majority of cases run a self-limited course, up to 69 % of eyes may develop
CNV, and furthermore about half of eyes develop subretinal fibrosis with consequent visual loss
often characterized by enlarging and new scotomata and in some cases further impairment of vision.
Khan OA, Taylor SRJ, Swart M, Jones JG (1997) The effects of low dose isoflurane on inhibition of saccadic generation, British Journal of Anaesthesia(79)pp. 576-576
Kabasele P, Lightman S, Taylor SRJ (2012) Visual loss in uveitis: outcomes and causes,
Tomkins-Netzer O, Bar A, Taylor SRJ, Lightman S (2012) Long-term outcomes in birdshot chorioretinopathy,
de Smet MD, Taylor SRJ, Bodaghi B, Miserocchi E, Murray PI, Pleyer U, Zierhut M, Barisani-Asenbauer T, Phuc L, Lightman S (2011) Understanding uveitis: The impact of research on visual outcomes, PROGRESS IN RETINAL AND EYE RESEARCH30(6)pp. 452-470 PERGAMON-ELSEVIER SCIENCE LTD
Tan LT, Davagnaman I, Isa H, Taylor SRJ, Rose GE, Verity DH, Pusey CD, Lightman S (2013) Clinical and imaging features predictive of granulomatosis with polyangiitis in orbital inflammation,
Tan LT, Davagnanam I, Isa H, Taylor SR, Rose GE, Verity DH, Pusey CD, Lightman S (2014) Clinical and Imaging Features Predictive of Orbital Granulomatosis with Polyangiitis and the Risk of Systemic Involvement, OPHTHALMOLOGY121(6)pp. 1304-1309 ELSEVIER SCIENCE INC
Taylor SR, Elliott JI (2007) The P2X7 Receptor in Ocular Inflammatory Disease, Invest Ophthalmol Vis Sci48
Tempest-Roe S, Tam FW, Taylor SRJ (2013) The phenotype of dendritic cell, but not macrophage, P2X7 responses is independent of the duration of LPS priming, Immunology
Taylor SRJ, Khan OA, Swart M, Jones JG (1997) The effects of low-dose isoflurane on contrast sensitivity in volunteers, British Journal of Anaesthesia(79)pp. 576-576
Joshi L, Menezo V, Yaganti S, Talat L, Lightman S, Taylor SRJ (2013) Uveitis refractory to mycophenolate mofetil: value & safety of switching or adding alternative non-biological agents,
Muthusamy K, Lightman S, Taylor SRJ (2011) The eye in renal disease, BRITISH JOURNAL OF HOSPITAL MEDICINE72(12)pp. 686-690 MA HEALTHCARE LTD
Tomkins-Netzer O, Taylor SRJ, Lightman S (2013) Can Rituximab Induce Long-Term Disease Remission in Patients with Intra-Ocular Non-Infectious Inflammation?, OPHTHALMOLOGICA230(3)pp. 109-115 KARGER
Gementzi M, Karydis A, Shao EH, Menezo V, Taylor SR (2014) Intensive intravitreal methotrexate for refractory cystoid macular oedema secondary to intraocular inflammation: a small case series,
Taylor SRJ, Tadayoni R, Pearce I, Warburton J, Margaron P, Wright J, Lambrou G (2014) Visual acuity outcomes in patients with retinal vein occlusion treated with ranibizumab according to baseline ischaemic status: an analysis of BRIGHTER and CRUISE,
Aim: To evaluate the visual acuity outcomes with ranibizumab (RBZ) according to baseline ischaemic status in patients with macular oedema secondary to branch or central retinal vein occlusion (BRVO and CRVO) Methods: Analysis of 2 multicenter randomized clinical trials (CRUISE and BRIGHTER) Results: Data of 392 CRVO patients randomized in CRUISE and 455 BRVO patients randomized in BRIGHTER were analysed. Best-corrected visual acuity (BCVA) was measured using ETDRS charts at each visit. Presence or absence of retinal ischaemia at baseline was assessed by fluorescein angiography by the central reading centre (CRC). In CRUISE, ischaemia was defined as >30% total capillary loss in the center subfield by area. In BRIGHTER, ischaemia was defined as present if capillary loss was detected and scored as mild, moderate, severe or complete in at least one location of the center, inner or outer subfields. Baseline visual acuity, and change from baseline were reported according to ischaemic status as a post-hoc analysis over 12 months for CRUISE and as a pre-defined exploratory analysis over 6 months for BRIGHTER. In addition, data on injection requirements during the PRN phase of CRUISE (months 7-12) were analysed. Data for RBZ treatment arms (0.3mg and 0.5mg) were combined in the CRUISE analysis. Data were available for 334 patients in CRUISE (ischaemic; RBZ n=15, sham n=4: non-ischaemic; RBZ n=207, sham n=108) and 291 patients in BRIGHTER (ischaemic; RBZ n=87, RBZ + laser n=71, laser n=41: non-ischaemic; RBZ n=35, RBZ+L n=37, laser n=20). In CRUISE, the mean baseline BCVA was substantially lower for ischaemic versus non-ischaemic patients in both RBZ (37.5 vs 49.8 letters) and sham (29.5 vs 49.4 letters) treatment arms respectively. Baseline central retinal thickness and disease duration prior to enrolment were similar for all groups. In BRIGHTER, the mean baseline BCVA was slightly lower for ischaemic versus non-ischaemic patients in the RBZ+L (58.7 vs 60.4 letters) and Laser (55.6 vs 60.6 letters) respectively, but equal for RBZ (60.6 for both groups). In CRUISE and BRIGHTER, patients treated with RBZ achieved significantly greater gains in BCVA compared to the control arms irrespective of ischaemic status. In CRUISE, CRVO patients treated with RBZ achieved substantial gains in BCVA from baseline at month 6 (16.7 vs 14.4 letters) and month 12 (20.1 vs 14.7 letters) for ischaemic vs non-ischaemic patients respectively. The same was true in BRVO patients in BRIGHTER
Taylor SRJ (2008) Malignancies of the Posterior Segment, Optometry Today
Tomkins-Netzer O, Bar A, Taylor SRJ, Lightman S (2012) Visual outcome in birdshot chorioretinopathy,
Talat L, Tomkins-Netzer O, Taylor SRJ, Din NM, Bar A, Isa H, Lightman S (2014) The influence of diabetes mellitus on the management and visual outcome of patients with uveitis, ACTA OPHTHALMOLOGICA92(4)pp. e329-e330 WILEY-BLACKWELL
Sallam A, Taylor SRJ, Khan A, Mccluskey P, Lynn WA, Manku K, Pacheco PA, Lightman S (2012) FACTORS DETERMINING VISUAL OUTCOME IN ENDOGENOUS CANDIDA ENDOPHTHALMITIS, RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES32(6)pp. 1129-1134 LIPPINCOTT WILLIAMS & WILKINS
Brand C, Musadiq M, Yang Y, Taylor SRJ, Gale R, Brittain C, Hamilton R (2013) Baseline characteristics of the UK wet age-related macular degeneration (wAMD) cohort of the LUMINOUS observational study,
Khan O, Taylor SJ, Jones JG, Swart M, Hanes DP, Carpenter RHS (1999) Effects of low-dose isoflurane on saccadic eye movement generation, ANAESTHESIA54(2)pp. 142-145 BLACKWELL SCIENCE LTD
Taylor SRJ, Khan OA, Swart ML, Lockwood GG, Jones JG (1998) Effects of a low concentration of isoflurane on contrast sensitivity in volunteers, BRITISH JOURNAL OF ANAESTHESIA81(2)pp. 176-179 PROF SCI PUBL
Tomkins-Netzer O, Taylor SRJ, Lightman S (2013) Factors Affecting the Long-term Visual Prognosis in Birdshot Chorioretinopathy,
Khan OA, Taylor SRJ, Jones JG (2000) Anaesthesia and saccadic eye movements, ANAESTHESIA55(9)pp. 877-882 BLACKWELL SCIENCE LTD
Sallam A, Taylor SRJ, Habot-Wilner Z, Elgohary M, Do HH, McCluskey P, Lightman S (2012) Repeat intravitreal triamcinolone acetonide injections in uveitic macular oedema, ACTA OPHTHALMOLOGICA90(4)pp. E323-E325 WILEY-BLACKWELL
Bar A, Tomkins-Netzer O, Taylor SRJ, Lightman S (2012) Visual loss in uveitis,
Taylor SRJ, Aylward GW (2005) Endophthalmitis following 25-gauge vitrectomy, EYE19(11)pp. 1228-1229 NATURE PUBLISHING GROUP
Zaheer I, Taylor SRJ, Pearson RV (2007) Phacoemulsification in vitrectomized eyes under topical anesthesia, EUROPEAN JOURNAL OF OPHTHALMOLOGY17(3)pp. 336-340 WICHTIG EDITORE
Khot A, Dignan F, Taylor S, Potter M, Cubitt D, Treleaven JG (2006) Another case of PORN (bilateral progressive outer retinal necrosis) after allogeneic stem cell transplantation, BONE MARROW TRANSPLANTATION37(1)pp. 113-114 NATURE PUBLISHING GROUP
Tomkins-Netzer O, Taylor SRJ, Lightman S (2013) Long-term clinical outcomes among patients with birdshot chorioretinopathy,
Shao EH, Dong YL, Dave R, Taylor SR, Sivagnanavel V (2014) Rebound increase in VEGF levels following intravitreal injection of bevacizumab in a child,
Shirodkar A, Lightman S, Taylor SRJ (2010) Good Medical Practice - Causes of Visual Loss: Data from Population Studies, Foundation Years Journal6(4)pp. 26-31
We report the case of a patient treated with dabrafenib and trametinib (mitogen-activated protein kinase pathway inhibitors) for stage 3b cutaneous melanoma who developed bilateral uveitis. Although there have been reports of ocular side effects with this class of drugs, uveitis has not been previously reported to the best of our knowledge. This case indicates the wide range of side effects that can be seen with the newer targeted biological therapies.
Taylor SR (2013) COMRADE-B trial of Ranibizumab vs. Dexamethasone in Branch Retinal Vein Occlusion: Exploratory Analysis,
Joshi L, Lightman SL, Salama AD, Shirodkar AL, Pusey CD, Taylor SRJ (2011) Rituximab in Refractory Ophthalmic Wegener's Granulomatosis PR3 Titers May Predict Relapse, But Repeat Treatment Can Be Effective, OPHTHALMOLOGY118(12)pp. 2498-2503 ELSEVIER SCIENCE INC
Menezo V, Taylor SR (2014) Birdshot uveitis: current and emerging treatment options., Clinical ophthalmology (Auckland, N.Z.)8pp. 73-81
Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded - central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve.
Taylor SRJ, Habot-Wilner Z, Pacheco P, Lightman SL (2009) Intraocular Methotrexate in the Treatment of Uveitis and Uveitic Cystoid Macular Edema, OPHTHALMOLOGY116(4)pp. 797-801 ELSEVIER SCIENCE INC
Sallam A, Taylor SRJ, Lightman S (2011) Review and update of intraocular therapy in noninfectious uveitis, CURRENT OPINION IN OPHTHALMOLOGY22(6)pp. 517-522 LIPPINCOTT WILLIAMS & WILKINS
Shalchi Z, Lightman SL, Pusey CD, Taylor SRJ (2012) A sore red eye with systemic involvement, BRITISH MEDICAL JOURNAL344ARTN e1121 B M J PUBLISHING GROUP
Singh J, Sallam A, Lightman S, Taylor SRJ (2011) Episcleritis and scleritis in the rheumatic diseases, Current Rheumatology Reviews7pp. 24-30
Yang DSF, Taylor SRJ, Lightman SL (2008) Interferon-alpha in the management of patients with Behcet's disease, BRITISH JOURNAL OF HOSPITAL MEDICINE69(10)pp. 575-+ MA HEALTHCARE LTD
Taylor SRJ (2010) Multifocal Choroiditis, Royal College of Ophthalmologists
Multifocal choroiditis forms a subset of the white-dot syndromes in which inflammation is focussed on the choroid. Multifocal choroiditis with panuveitis (MCP), punctate inner choroidopathy (PIC) and birdshot chorioretinopathy (BCR) have been distinguished, although some consider PIC to be a variant of MCP. The aetiology is largely unknown and treatment is with local or systemic corticosteroids as well as immunosuppressive agents. Visual prognosis depends on the adverse effects of uveitis.
Shalchi Z, Taylor SRJ, Lightman S (2011) The eye in haematological disease, BRITISH JOURNAL OF HOSPITAL MEDICINE72(12)pp. 691-697 MA HEALTHCARE LTD
Purpose: To determine risk factors for intraocular pressure (IOP) elevation and glaucoma in children with nonjuvenile idiopathic arthritis?related uveitis and any IOP-related changes in the retinal nerve fiber layer (RNFL) thickness.
Patients and Methods: Clinical data were collected from children attending a tertiary referral uveitis clinic between May 2010 and October 2012. We assigned 206 eyes of 103 children into 32 normal eyes, 108 normotensive uveitics (NU), 41 hypertensive uveitics (HU: raised IOP without glaucomatous disc), and 25 glaucomatous uveitics (GU: raised IOP with glaucomatous disc). Risk factors for raised IOP, glaucoma and steroid response (SR) were evaluated and RNFL thickness across groups was compared with determine changes related to raised IOP.
Results: IOP elevation occurred in 40 patients (38.8%) or 66/174 eyes with uveitis (37.9%); and SR occurred in 35.1% of all corticosteroid-treated eyes. Chronic uveitis was a significant risk factor for raised IOP [odds ratio (OR)=9.28, P=0.001], glaucoma, and SR (OR=8.4, P<0.001). Higher peak IOP was also a risk factor for glaucoma (OR=1.4, P=0.003). About 70% of SR eyes were high responders (IOP increase >15 mm Hg from baseline), associated with younger age and corticosteroid injections. Although no significant RNFL thinning was detected between HU and NU eyes, significant thinning was detected in the inferior quadrant of GU (121.3±28.9 ¼m) compared with NU eyes (142.1±32.0 ¼m, P=0.043).
Conclusions: Children with chronic uveitis are at higher risk of raised IOP and glaucoma. Thinning of the inferior RNFL quadrant may suggest glaucomatous changes in uveitic children with raised IOP.
Kabasele PMB, Taylor SR, Lightman SL (2010) INCIDENCE OF UVEITIS DUE TO BEHCET DISEASE AND COMPLICATIONS, CLINICAL AND EXPERIMENTAL RHEUMATOLOGY28(4)pp. S146-S146 CLINICAL & EXPER RHEUMATOLOGY
Tomkins-Netzer O, Taylor SRJ, Lightman S (2014) Long-term Clinical and Anatomic Outcome of Birdshot Chorioretinopathy, JAMA OPHTHALMOLOGY132(1)pp. 57-62 AMER MEDICAL ASSOC
Hamilton R, Taylor SRJ, Warburton J, Johnstone R, Patel P, Burton B, Brand C (2014) Clinical outcomes in the UK for 866 patients with wet age-related macular degeneration (AMD) treated with ranibizumab for 1 year using an individualised patient treatment approach- LUMINOUS UK interim 1 year results,
Purpose: The efficacy and safety profile of ranibizumab is well described based on randomized controlled trials involving >10,000 patients across five indications. However, real-world long term safety and effectiveness have not been widely documented in large populations across diverse regions. The LUMINOUS study (NCT01318941) is designed to assess the long-term safety, effectiveness, treatment-patterns and health-related quality of life associated with ranibizumab treatment in a real-world setting. Here, we present data from the wet age-related macular degeneration (wAMD) cohort from the planned first year interim analyses of the LUMINOUS study Setting: LUMINOUS is an ongoing observational, non-interventional, open-label, multicenter study currently conducted in over 30 countries. Patients treated with ranibizumab for any approved indication in the local product label are recruited Methods: The LUMINOUS study aims to enrol 30,000 patients from 600 sites in 41 countries. Consenting adult patients (treatment naïve or previously treated with ranibizumab or other ocular treatment) were enrolled. Exclusion criteria were simultaneous participation in another investigational study, or systemic/ocular vascular endothelial growth factor (VEGF) inhibitor administration other than ranibizumab in the 90 days prior to study enrolment. Of the 2163 patients recruited up to March 2012, 97.7% had wAMD, 1.7% had diabetic macular edema and 0.6% had retinal vein occlusion. Here, we present the one-year follow up data from the wAMD cohort. In this wAMD cohort (n=2112), 275 (13.0%) were treatment naive (T1), 1829 (86.6%) had previous ranibizumab treatment (T2) and eight (0.4%) had previously received other ocular treatments (T3). Pre-treatment status was defined by the primary-treated eye Results: At baseline, mean age was 79.2 years, 61.8% were female, and 93.7% were Caucasian. The baseline mean visual acuity (VA, ETDRS letter score) was 52.4 and 60.3 for T1 and T2, respectively. The median time from diagnosis to first treatment was 0.04 years (2 weeks) for T1 and the median time from diagnosis to study entry was 1.70 years for T2. Pre-treatment with ranibizumab (T2) was associated with higher VA (60.3/52.4 letters) and lower central retinal thickness (CRT; 255.0/339.7µm) at baseline than the treatment naïve group (T1). At 12 months, patients in T1 gained 4.1 letters, whilst T2 patients generally maintained their higher level of baseline VA (-1.1 letters). Both T1 and T2 grou
A 68-year-old man developed bilateral sequential non-arteritic anterior ischaemic optic neuropathy, each episode occurring with a close temporal relationship to influenza vaccination.
Isa H, Tan LT, Lightman S, Taylor SRJ (2012) Histological features on orbital biopsy predictive of outcome in Wegener's granulomatosis,
Singh J, Taylor SRJ, Stanford M, Lightman S (2011) Visual loss in Behcet's disease,
Joshi L, Hamour S, Salama AD, Pusey CD, Lightman S, Taylor SR (2009) Renal & ocular targets for therapy in Wegener's granulomatosis., Inflammation & allergy drug targets8(1)pp. 70-79
Wegener's granulomatosis (WG) is a multisystem small-vessel vasculitis which is characterised by granulomatous inflammation. Respiratory tract involvement is most commonly seen, affecting up to 85% of patients, closely followed by the renal system in up to 75% of patients; ocular involvement in WG is estimated to occur in 50-60% of patients. The purpose of this review is to provide an overview of the renal and ocular manifestations of WG and discuss the rationale behind the therapeutic approach. In particular, we will focus on how understanding the disease processes in both of these organs has led to more targeted therapy. The mechanism of action of the various immunosuppressive medications in both systemic and ocular inflammation and the evidence available for their use will also be discussed.
Taylor S, Lightman S (2004) Recurrent anterior uveitis in patients with Vogt-Koyanagi-Harada syndrome, ARCHIVES OF OPHTHALMOLOGY122(6)pp. 922-923 AMER MEDICAL ASSOC
Din NM, Taylor SRJ, Isa H, Tomkins-Netzer O, Bar A, Talat L, Lightman S (2014) Evaluation of Retinal Nerve Fiber Layer Thickness in Eyes With Hypertensive Uveitis, JAMA OPHTHALMOLOGY132(7)pp. 859-865 AMER MEDICAL ASSOC
Taylor SRJ, Sallam A, Khan A, McCluskey P, Lynn WA, Manku K, Pacheco PA, Lightman S (2013) Untitled Reply,RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES33(2)pp. 454-456
LIPPINCOTT WILLIAMS & WILKINS
Shao E, Atkins K, Tam FW, Taylor SRJ VEGF changes in diabetic macular oedema treated with intravitreal anti-VEGF injections,
Taylor SRJ, Singh J, Menezo V, Wakefield D, McCluskey P, Lightman S (2011) Behcet Disease: Visual Prognosis and Factors Influencing the Development of Visual Loss, AMERICAN JOURNAL OF OPHTHALMOLOGY152(6)pp. 1059-1066 ELSEVIER SCIENCE INC
Tempest-Roe S, Shao EH, McDaid J, Taylor SR (2014) P2X7 deficiency protects against experimental autoimmune uveitis,
Sallam A, Taylor S (2009) Ocular emergencies 2: non-traumatic., Br J Hosp Med (Lond)70(4)pp. M54-M58
Joshi L, Tomkins-Netzer O, Menezo V, Sallam A, Kirkpatrick N, Lightman S, Taylor SRJ (2013) Dexamethasone implants and neovascular glaucoma in central retinal vein occlusion, ACTA OPHTHALMOLOGICA91(3)pp. E239-E240 WILEY-BLACKWELL
Taylor SRJ, Pacheco PA, Lightman S (2011) Dry eye in the rheumatic diseases, Current Rheumatology Reviews7pp. 15-23
Tomkins-Netzer O, Taylor SR, Lightman S (2012) Corticosteroid-sparing agents: new treatment options., Developments in ophthalmology51pp. 47-56
Corticosteroids form the cornerstone of treatment for noninfectious uveitis, but their safety profile and adverse effects render their use a double-edged sword. As a result, the local benefits of treating ocular inflammation may be outweighed by systemic adverse effects, and it is mainly for this reason that steroid-sparing agents are used. Most of these systemic immunomodulatory drugs used in ophthalmology have been adopted from other specialties, such as rheumatology and, while their safety profiles make them valid alternatives to long-term high-dose corticosteroids, systemic side effects still prove problematic for a significant proportion of patients. The desire to avoid these systemic side effects has driven the continuing search for effective agents with an improved safety profile, but also the increasing use of local drug administration, which avoids systemic side-effects, but may lead to ocular complications. Here we review both approaches and discuss the possible risks and benefits of each.
Tempest-Roe S, Tam FW, Taylor SRJ The P2X7 receptor is a potential therapeutic target for the treatment of Uveitis,
Shao EH, Menezo V, Taylor SRJ (2014) Birdshot chorioretinopathy, CURRENT OPINION IN OPHTHALMOLOGY25(6)pp. 488-494 LIPPINCOTT WILLIAMS & WILKINS
Taylor SRJ, Isa H, Joshi L, Lightman S (2010) New Developments in Corticosteroid Therapy for Uveitis, OPHTHALMOLOGICA224pp. 46-53 KARGER
Karydis A, Shao EH, Gemenetzi M, Taylor SR (2014) Intravitreal bevacizumab results in greater functional improvements in visual acuity compared to intravitreal ozurdex at 3 months in retinal vein occlusions,
Gangaputra SS, Altaweel MM, Peng Q, Friedman DS, Rao PK, Foster CS, Kim RY, Reed SB, Srivastava SK, Wong IG, Kempen JH (2011) Morphologic Assessment for Glaucoma in the Multicenter Uveitis Steroid Treatment (MUST) Trial, Ocular Immunology and Inflammation19(4)pp. 267-274
Isa H, Luthert P, Rose G, Verity D, Pusey C, Tomkins-Netzer O, Din NM, Teak TL, Taylor S, Lightman S (2015) Tissue Interleukin-17 and Interleukin-23 as Biomarkers for Orbital Granulomatosis with Polyangiitis, OPHTHALMOLOGY122(10)pp. 2140-2142 ELSEVIER SCIENCE INC
Joshi L, Yaganti S, Gemenetzi M, Lightman S, Lindfield D, Liolios V, Menezo V, Shao E, Taylor SRJ (2013) Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed, BRITISH JOURNAL OF OPHTHALMOLOGY97(8)pp. 1040-1044 BMJ PUBLISHING GROUP
Joshi L, Talat L, Yaganti S, Sandhu S, Taylor SRJ, Wakefield D, McCluskey P, Lightman S (2014) Outcomes of Changing Immunosuppressive Therapy after Treatment Failure in Patients with Noninfectious Uveitis, OPHTHALMOLOGY121(5)pp. 1119-1124 ELSEVIER SCIENCE INC
Taylor SRJ, Lightman SL, Sugar EA, Jaffe GJ, Freeman WR, Altaweel MM, Kozak I, Holbrook JT, Jabs DA, Kempen JH (2012) The Impact of Macular Edema on Visual Function in Intermediate, Posterior, and Panuveitis, OCULAR IMMUNOLOGY AND INFLAMMATION20(3)pp. 171-181 INFORMA HEALTHCARE
Taylor SRJ, Lim R (2015) Evaluation of a modified graft-free technique of Ahmed glaucoma valve (AGV) implantation,
Title: Evaluation of a modified graft-free technique of Ahmed glaucoma valve (AGV) implantation Purpose: To determine the outcome of AGV implanted via a scleral tunnel, without using any patch grafts. Method: Retrospective case series of 18 consecutive patients undergoing AGV via scleral tunnels in a single hospital from 2011-2015. Results: The mean follow-up was 1.7 ± 1.4 years. The mean age of the patients at the time of surgery was 73.4 ± 9.2 years old. The cases include 72% neovascular glaucoma, 11% primary open angle glaucoma, 6% posner schlossman, 6% pseudoexfoliation and 6% uveitic glaucoma. Mean intraocular pressures (IOPs) before and after AGV implant were 40.8 ± 11.9mmHg and 15.9 ± 7.9mmHg respectively. Median visual acuity before and after AGV implant were both counting fingers. There was no tube erosion noted, although 2 patients (11%) had end-plate erosion, requiring explantation of the AGV. Other post-operative complications (occurring at any point) include hyphaemas >1mm (33%), choroidal effusions (22%), shallow AC requiring healon injection (6%), tenon?s cyst requiring excision (6%) and fibrosed bleb requiring needling (6%). All hyphaemas and choroidal effusions resolved without intervention. Success at final follow-up (IOP between 5 and 21mm Hg with least 20% reduction from baseline IOP, without additional glaucoma surgery nor loss of light perception) was 72%. Conclusion: In this graft-free technique of AGV implantation, there were no tube erosions but 2 patients (11%) had end-plate exposure. This end-plate exposure rate is comparable to the range reported in traditional AGV implant using patch-grafts.
Hooper CY, Taylor SRJ, Lightman S (2011) Uveitis in the rheumatic diseases, Current Rheumatology Reviews7pp. 31-38
Tempest-Roe S, Joshi L, Dick AD, Taylor SR (2013) Local therapies for inflammatory eye disease in translation: past, present and future., BMC Ophthalmol13(1)
Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids remains in the management of patients with uveitis, particularly when inflammation is associated with systemic disease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior uveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate intraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal inserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted when ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the systemic medication.Implants in particular have gained prominence with evidence of efficacy including both dexamethasone and fluocinolone loaded devices. However, an appealing avenue of research lies in the development of non-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids. Several existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab, anti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as methotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase 3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets. Furthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as high affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher specificity and possibility of topical delivery.
Shirodkhar A-L, Lightman S, Taylor SRJ (2012) Management of branch retinal vein occlusion, BRITISH JOURNAL OF HOSPITAL MEDICINE73(1)pp. 20-23 MA HEALTHCARE LTD
Joshi L, Taylor SRJ, Large O, Yacoub S, Lightman S (2009) A Case of Optic Neuropathy after Short-Term Linezolid Use in a Patient with Acute Lymphocytic Leukemia, CLINICAL INFECTIOUS DISEASES48(7)pp. e73-e74 UNIV CHICAGO PRESS
Taylor SRJ, Lightman S (2003) The eye in cardiac and cardiovascular disease, British Journal of Hospital Medicine5(64)pp. 299-302
Lightman S, Taylor SRJ, Bunce C, Longhurst H, Lynn W, Moots R, Stanford M, Tomkins-Netzer O, Yang D, Calder VL, Haskard DO (2015) Pegylated interferon-alpha-2b reduces corticosteroid requirement in patients with Behcet's disease with upregulation of circulating regulatory T cells and reduction of Th17, ANNALS OF THE RHEUMATIC DISEASES74(6)pp. 1138-1144 BMJ PUBLISHING GROUP
Tempest-Roe S Novel therapeutic mechanisms in uveitis,
Taylor SRJ, Hamilton R, Hooper CY, Joshi L, Morarji J, Gupta N, Lightman SL (2012) Valacyclovir in the treatment of acute retinal necrosis, BMC OPHTHALMOLOGY12(ARTN 48) BIOMED CENTRAL LTD
Background: To report the outcome of oral valacyclovir as the sole antiviral therapy for patients with acute retinal
Methods: This study reports a retrospective, interventional case series of nine consecutive patients with ten eyes with
newly diagnosed ARN treated with oral valacyclovir as the sole antiviral agent. Eight patients received oral valacyclovir 2 g
tid (Valtrex, GlaxoSmithKline) and one patient with impaired renal function received oral 1 g tid. The main outcome
measures were response to treatment, time to initial response to treatment, time to complete resolution of retinitis, best
corrected visual acuity (BCVA) at final follow-up, retinal detachment and development of recurrent or second eye disease.
Results: Retinitis resolved in ten of ten (100%) affected eyes. The median time to initial detectable response was seven
days and the median time to complete resolution was 21 days. A final BCVA of 20/40 or better was achieved in 6/10
(60%) of eyes. 3/10 eyes (30%) developed a retinal detachment. No patients developed either disease reactivation or
second eye involvement over the course of the study (mean follow up 31 weeks, range 7 to 104 weeks).
Conclusions: Treatment with oral valacyclovir as the sole antiviral therapy resulted in complete resolution of retinitis.
Final BCVA and retinal detachment rate were comparable with previously reported outcomes for intravenous acyclovir
We report a patient with necrotising scleritis in whom infliximab was used for short-term steroid-sparing while rituximab took effect. This enabled disease control without requiring an extended period of high-dose corticosteroid administration or the concurrent use of cyclophosphamide.
Isa H, Lightman S, Luthert PJ, Rose GE, Verity DH, Taylor SRJ (2012) Histopathological features predictive of a clinical diagnosis of ophthalmic granulomatosis with polyangiitis (GPA), INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY5(7)pp. 684-689 E-CENTURY PUBLISHING CORP
Joshi L, Shirodkhar A, Taylor SRJ, Lightman S (2011) The ocular features of TB infection,
Taylor SR, Zaheer I, Patel PJ, Karia N (2005) Spontaneous Resolution of Vitreomacular Traction in Young Patients, Invest Ophthalmol Vis Sci46
Taylor SRJ, Turner CM, Elliott JI, McDaid J, Hewitt R, Smith J, Pickering MC, Whitehouse DL, Cook HT, Burnstock G, Pusey CD, Unwin RJ, Tam FWK (2009) P2X(7) Deficiency Attenuates Renal Injury in Experimental Glomerulonephritis, JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY20(6)pp. 1275-1281 AMER SOC NEPHROLOGY
Shao EH, Sivagnanavel V, Dabbagh A, Dave R, Tempest-Roe S, Tam FWK, Taylor SR (2015) Multiphasic changes in systemic VEGF following intravitreal injections of ranibizumab in a child, EYE29(4)pp. 569-573 NATURE PUBLISHING GROUP
Joshi L, Singh J, Tan LT, Taylor SRJ, Lightman S (2011) Developing an electronic virtual patient in ophthalmology for medical undergraduates,
Joshi L, Morarji J, Tomkins-Netzer O, Lightman S, Taylor SR (2012) Rhizobium radiobacter Endophthalmitis following Intravitreal Ranibizumab Injection., Case reports in ophthalmology3(3)pp. 283-285
We present the first reported case of acute endophthalmitis due to Rhizobium radiobacter after an intravitreal injection of ranibizumab for neovascular age-related macular degeneration.
Joshi L, Taylor SR, Lightman S (2009) Uveitis in Ankylosing Spondylitis,
Patient Information Leaflet
Morarji J, Lightman S, Taylor SRJ (2011) The eye in rheumatology, BRITISH JOURNAL OF HOSPITAL MEDICINE72(12)pp. 682-685 MA HEALTHCARE LTD
Taylor SRJ, Joshi L, Lightman S (2011) Rituximab in ocular disease,
Joshi L, Taylor SRJ, Large O, Lightman S (2009) Optic Neuropathy following Linezolid Use in a Patient with Acute Lymphocytic Leukemia Reply, CLINICAL INFECTIOUS DISEASES49(4)pp. 646-646 UNIV CHICAGO PRESS
Taylor SRJ, Lightman S, Sugar EA, Jaffe GJ, Altaweel MA, Kozak I, Holbrook JT, Jabs DA, Kempen JH (2012) The impact of macular edema on visual function in uveitis,
Joshi L, Lightman S, Taylor SRJ (2012) PR3 titres predict relapse following rituximab therapy in Wegener's granulomatosis,
Robins J, Lightman S, Taylor SRJ (2011) The eye in virology, BRITISH JOURNAL OF HOSPITAL MEDICINE72(12)pp. 672-676 MA HEALTHCARE LTD
Taylor SRJ, Alexander DR, Cooper JC, Higgins CF, Elliott JI (2007) Regulatory T cells are resistant to apoptosis via TCR but not P2X(7), JOURNAL OF IMMUNOLOGY178(6)pp. 3474-3482 AMER ASSOC IMMUNOLOGISTS
Hattenbach LO, Hoerauf H, Feltgen N, Lang G, Taylor S, Schmitz-Valckenberg S, Wolf A, Knorr T (2014) Efficacy and Safety of 0.5 mg Ranibizumab Administered as Intravitreal Injections PRN Compared with Intravitreal Implant Containing 0.7 mg Dexamethasone in Patients with Branch Retinal Vein Occlusion Over 6 Months: The COMRADE-B Study, OPHTHALMOLOGICA232pp. 90-90 KARGER
The treatment of uveitis is undergoing significant change as a result of the development of new therapeutic approaches, of which the biologic agents form a major part. These targeted therapies have shown great promise for the treatment of refractory disease and some have now undergone systematic evaluation through prospective clinical trials, unlike many of their predecessor drugs.
Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer?s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange
Hattenbach L, Feltgen N, Bertelmann T, Schmitz-Valckenberg S, Berk H, Eter N, Lang G, Rehak M, Taylor S, Wolf A, Weiss C, Paulus E, Pielen A, Hoerauf H (2017) Head-to-head comparison of ranibizumab PRN versus single-dose dexamethasone for branch retinal vein occlusion (COMRADE-B),Acta Ophthalmologica96(1)pp. e10-e18
Purpose: To compare the efficacy and safety of ranibizumab 0.5 mg versus dexamethasone 0.7 mg according to their European labels in macular oedema secondary to branch retinal vein occlusion (BRVO) in a 6-month, phase IIIb, randomized trial. Methods: Patients received eithermonthly ranibizumabfor 3 months followed byPro re nata (PRN) treatment (n = 126) or a sustained-release dexamethasone implant followedbyPRNshaminjections (n = 118).Mainoutcomesweremeanaveragechange in best-corrected visual acuity(BCVA)frombaseline tomonth1throughmonth6,mean changes inBCVAand foveal centre point thickness (FCPT), and adverse events (AEs). Results: There was no difference in BCVA gains between the treatments prior to month 3. Best-corrected visual acuity (BCVA) gain with dexamethasone declined thereafter. From month 3 to month 6, mean BCVA change from baseline was significantly higher with ranibizumab than with dexamethasone [raw means (standard deviation):+16.2 ( 11) letters versus+9.3 ( 10.1) letters].Atmonth 6, the difference in BCVA gains from baseline was +17.3 letters in the ranibizumab versus +9.2 letters in the dexamethasone group. Patients in the ranibizumab group received a mean of 2.94 loading injections and 1.74 PRN retreatment injections, while those in the dexamethasone group received a single loading injection. Elevated intraocular pressure (IOP) and AEs were more frequent with dexamethasone than ranibizumab treatment. Conclusion: Ranibizumab PRN resulted in greater visual acuity (VA) gains in macular oedema following BRVO compared with single-dose dexamethasone over a 6-month study period, observed from month 3, when administered according to their European label. In clinical practice, retreatment with dexamethasone may be required prior to this point.
Uveitis involving the posterior segment is a sight-threatening condition that can
be associated with multiple underlying ocular and systemic diseases. Accurate
diagnosis is the foundation for selecting treatment that can preserve vision and
is guided by the findings of a thorough history, clinical examination, laboratory
testing, and imaging. Evaluation and management of posterior uveitis varies
globally, however, because of geographic/ethnic variation in its causes, differences
in local practices, and varying access to diagnostic modalities and treatments.
This case-based program captures the highlights of a roundtable discussion,
in which an international panel of uveitis subspecialists provides their expert
perspectives on the diagnosis and management of uveitis involving the posterior
segment, including the role of emerging diagnostic techniques and new and
emerging therapies. The cases are from the files of Sunil K. Srivastava, MD.
To characterize the risk uveitis, scleritis or episcleritis in relation to diabetes, glycaemic control, and co-existence of retinopathy.
Using the Royal College of General Practitioners Research and Surveillance Centre database, we established the prevalence of acute uveitis and scleritis or episcleritis over a six-year period among populations without(n/=/889,856) and with diabetes(n/=/48,584). We evaluated the impact of glycaemic control on disease risk. Regression modeling was used to identify associations, adjusting for clinical and demographic confounders.
Incidence of acute uveitis was higher among patients with diabetes; Type 1 OR:2.01 (95% CI 1.18?3.41; p/=/0.009), and Type 2 OR:1.23 (1.05?1.44; p/=/0.01). Glycaemic control was established as an important effect modifier for uveitis risk, whereby those with poorer control suffered higher disease burden. Results confirmed a dose-response relationship such that very poor glycaemic control OR:4.72 (2.58?8.65; p/0.001), poor control OR:1.57 (1.05?2.33; p/=/0.03) and moderate control OR:1.20 (0.86?1.68; p/=/0.29) were predictive of uveitis. Similar results were observed when evaluating retinopathy staging: proliferative retinopathy OR:2.42 (1.25?4.69; p/=/0.01). These results were not maintained for scleritis or episcleritis.
Acute uveitis is more common in patients with diabetes; at highest risk are those with type 1 disease with poor glycaemic control. Glycaemic improvements may prevent recurrence.
Importance: Melanoma associated retinopathy (MAR) is a paraneoplastic syndrome in which anti-retinal antibodies cross-react with retinal on-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin (IVIg), corticosteroids or plasmapheresis, but their effectiveness is limited and there is concern given the possible protective role of circulating autoantibodies against metastatic spread. We report here three-year follow-up of the first case of MAR treated with intravitreal long-acting steroid implants.
Objectives: To report a case of MAR which was treated with intravitreal fluocinolone acetonide implants (FAc; Iluvien) in the absence of systemic immunosuppression.
Design, Setting and Participants: Three-year follow-up of a 73 year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence and optical coherence tomography were normal with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized on-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral FAc intravitreal implants.
Main outcomes and measures: Visual acuity, visual field and ERG testing for three years following treatment.
Results: Visual fields and ERGs improved and, at three years post treatment, the patient remained visually stable and in systemic disease remission.
Conclusions and relevance: We report to our knowledge the first case of MAR treated with intravitreal slow-release corticosteroid implants, showing improvements in visual symptoms, visual fields and retinal function. Detailed ERG monitoring indicated characteristic ERG abnormalities that partly resolved following treatment, consistent with improved inner retinal on-bipolar cell function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR although results from one case should be generalized with caution.