Petrina Tan

Evaluation of the Impact of Uveitis on Visual-related Quality of Life

Purpose: To determine quality of life in patients with uveitis and investigate the association between clinical parameters of uveitis and visual functioning. Methods: Prospective cross-sectional study. The interviewer- administered National Eye Institute visual function questionnaire (VFQ-25) was used in 117 adult outpatient uveitic patients. Their scores were compared against 48 controls with no ocular history. Subgroup differences amongst the patients were compared using Mann-Whitney and Kruskal-Wallis test. Multiple regression analysis was performed to determine the associations of visual function and disease characteristics of uveitis. Results: VFQ-25 composite scores for patients were significantly lower than controls in all domains except driving. In multivariable analysis, lower VFQ-25 composite scores were associated with a chronic course of disease, even after taking into account the influences of visual acuity, treatment regimes and location of disease. Conclusions: Uveitic patients reported poorer visual functioning. A chronic course of disease is associated with poorer functioning.

Severe optic neuritis in a patient with combined neuromyelitis optica spectrum disease and primary Sjögren's syndrome: a case report

IntroductionOptic neuritis, although uncommon, can be the initial presentation of Sjögren’s syndrome. Coexisting Sjögren’s syndrome has also been reported with neuromyelitis optica spectrum disorder. This case report highlights the association between the two diseases and the importance of rheumatological and neurological evaluations in patients with such diagnoses. Distinction of neuromyelitis optica with coexisting connective tissue disease has both prognostic and therapeutic significance for the patient.Case presentationWe report a case of a 56-year-old Chinese woman who presented with bilateral asymmetric visual loss secondary to optic neuritis. She was subsequently found to be seropositive for neuromyelitis optica immunoglobulin G (NMO-IgG) (anti-aquaporin-4 antibody) and was diagnosed with neuromyelitis optica spectrum disorder. She also fulfilled the international criteria for Sjögren’s syndrome. Despite initial high dose immunosuppressive therapy, she failed to regain vision in one eye.ConclusionPatients presenting with optic neuritis and severe visual loss should be screened for neuromyelitis optica and treated appropriately. Neuromyelitis optica has been associated with systemic autoimmune diseases, in particular Sjögren’s syndrome, and current evidence indicates that they are two distinct entities. We recommend that both diagnoses be considered in cases of optic neuritis with severe visual loss.

Retinal vascular parameter variations in patients with human immunodeficiency virus.

PURPOSE To compare the retinal vascular parameters in patients with human immunodeficiency virus (HIV) infection with normal controls, and to determine the relationship between retinal vascular parameters and HIV-related blood biomarkers (CD4(+) T-lymphocytes count, presence of HIV RNA). METHODS Case-control study of eighty-five patients with HIV on follow-up at the Communicable Disease Center, Singapore, and 251 age-, sex-, and race-matched normal healthy controls (case: control matching ≈ 1:3) selected from the Singapore Epidemiology of Eye Disease program were included in this study. Standardized retinal photographs were taken from patients and controls. Trained technicians measured quantitative retinal vascular parameters (retinal vascular caliber, branching angle, tortuosity, and fractal dimension) with a semiautomated computer-based program following a standardized protocol. RESULTS HIV-patients had more tortuous arterioles (0.77 × [10(4)] vs. 0.59 × [10(4)], P < 0.001) and venules (0.90 × [10(4)] vs. 0.74 × [10(4)], P < 0.001), compared with healthy normal subjects. Amongst the HIV-patients, increasing HIV viral loads were associated with decreased retinal arteriolar caliber (P trend = 0.009) and decreased arteriolar-venular ratio (P trend = 0.025). CONCLUSIONS Our study showed that patients with HIV have significant variations in retinal vasculature. Retinal vascular imaging may offer further insight into the pathophysiology behind HIV-related vascular disease in future.

A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection.

PURPOSE To investigate the tear cytokine profile in HIV patients with dry eye disease (DED) and study the association between the severity of ocular inflammatory complications and tear cytokines levels. We postulate that HIV-mediated inflammation may be the underlying pathogenic mechanism for HIV-associated DED. METHODS The current prospective case-control study compared tear film cytokine profiles in DED patients with HIV infection (n=34) and age/gender-matched DED patients without HIV infection [controls (n=32)]. Participants were recruited from tertiary referral eye care centre and communicable disease clinics, Singapore. Ocular surface health was documented using tear film, Schirmers test, corneal staining, and conjunctival injection measurements. Tear samples were collected using Schirmers strips and analysed for the levels of 41 cytokines using Luminex bead assay. Logistic regression models were performed to determine correlation and significance. RESULTS Among the 41 cytokines analysed, statistically significant differences were observed in the mean values of epithelial growth factor (EGF), growth related oncogene (GRO) and interferon gamma-induced protein 10 (IP-10). EGF and IP-10 levels were higher and GRO levels were lower in the tears of DED patients with HIV infection compared to DED patients without HIV infection. No significant association was found between varying levels of ocular surface parameters and cytokine concentrations in HIV patients with DED (p>0.05). CONCLUSIONS EGF and IP-10 were significantly elevated and GRO levels were lower in the tear profile of HIV patients with DED compared to immunocompetent patients with DED. This study suggests a novel cytokine driven paradigm for ocular inflammatory complications of HIV infection. Additional studies in large organised cohorts can validate the results.

Evaluation of the use of a nurse-administered telephone questionnaire for post-operative cataract surgery review

PURPOSE The purpose of this paper is to determine the safety of substituting the first day post-operative review after routine cataract surgery (phacoemulsification) with a telephone survey. DESIGN/METHODOLOGY/APPROACH Prospective non-randomised cohort study. A standardised questionnaire of five common ocular symptoms (general condition, vision, eye pain, headache, nausea or vomiting) was administered by a trained nurse on the first post-operative day. The patients were reviewed in clinic two to 14 days later. Patient charts were retrospectively reviewed for complications (endophthalmitis, raised intra-ocular pressure, wound leaks and uveitis) requiring deviation from standard treatment. FINDINGS Over 13 months, 256 eyes of 238 patients underwent uncomplicated phacoemulsification by four consultant surgeons. Only one patient reported poor general condition, blurred vision and eye pain. She was subsequently found to have corneal oedema and raised intra-ocular pressure when recalled for an earlier review. Best corrected visual acuity better than 20/40 was achieved in 80.5 per cent of patients. There were no other post-operative complications noted from medical records review. RESEARCH LIMITATIONS/IMPLICATIONS Non-randomised nature, skewed surgical expertise, lack of a control group and patient experience data. In all, 22 patients (9.2 per cent) were also uncontactable for the telephone interview. PRACTICAL IMPLICATIONS A nurse-administered telephone survey seemed to be a safe and effective alternative to first day post-operative review after routine phacoemulsification. The survey also enabled the detection of serious post-operative complications. The first day post-operative hospital visit may be safely substituted in a selected patient population with greater patient convenience achieved and liberation of clinic resources. ORIGINALITY/VALUE This is the first study which utilises a standardised questionnaire as a form of post-operative review in an Asian population.

Dataset of tear film cytokine levels in dry eye disease (DED) patients with and without HIV infection

The tear film cytokine profiling data in this article was obtained from a prospective case-control study with a sample size of 34 dry eye disease (DED) patients with HIV infection and 32 DED patients without HIV infection, see “A distinct cytokines profile in tear film of dry eye disease (DED) patients with HIV infection” (R. Agrawal, P.K. Balne, A. Veerappan, V.B. Au, B. Lee, E. Loo, A. Ghosh, L. Tong, S.C. Teoh, J. Connolly, P. Tan, 2016) [1]. Tear samples were collected from all the subjects using Schirmer׳s strips and cytokine profiling was done using the Luminex bead based multiplex assay with a panel of 41 analytes. The cytokine level differences in each group of subjects were analyzed using logistic regression models.

A prospective case-control study to investigate retinal microvascular changes in acute dengue infection.

Dengue infection can affect the microcirculation by direct viral infection or activation of inflammation. We aimed to determine whether measured retinal vascular parameters were associated with acute dengue infection. Patients with acute dengue were recruited from Communicable Diseases Center, Singapore and age-gender-ethnicity matched healthy controls were selected from a population-based study. Retinal photographs were taken on recruitment and convalescence. A spectrum of quantitative retinal microvascular parameters (retinal vascular caliber, fractal dimension, tortuosity and branching angle) was measured using a semi-automated computer-based program. (Singapore I Vessel Assessment, version 3.0). We included 62 dengue patients and 127 controls. Dengue cases were more likely to have wider retinal arteriolar and venular calibers (158.3 μm vs 144.3 μm, p < 0.001; 227.7 μm vs 212.8 μm, p < 0.001; respectively), higher arteriolar and venular fractal dimensions (1.271 vs 1.249, p = 0.002; 1.268 vs. 1.230, p < 0.001, respectively), higher arteriolar and venular tortuosity (0.730 vs 0.546 [x104], p < 0.001; 0.849 vs 0.658 [x104], p < 0.001; respectively), compared to controls. Resolution of acute dengue coincided with decrease in retinal vascular calibers and venular fractal dimension. Dengue patients have altered microvascular network in the retina; these changes may reflect pathophysiological processes in the immune system.

Dataset of longitudinal analysis of tear cytokine levels, CD4, CD8 counts and HIV viral load in dry eye patients with HIV infection

The data presented in this article shows the longitudinal analysis of tear fluid cytokine profiles, blood CD4 and CD8 counts and HIV viral load in 34 dry eye patients with HIV infection during the HAART therapy. Clinical samples were collected from HIV patients with dry eye disease at the time of presentation to the clinic (visit 1), three months (visit 2) and 6 months (visit 3) after the presentation. At each time point tear samples were evaluated for 41 cytokines using Luminex bead based multiplex assay and blood samples were tested for HIV viral load and CD4 and CD8 counts.

Retinal vascular changes and immune restoration in a cohort of HIV/AIDS patients on highly active antiretroviral therapy

Abstract Background Retinal microvascular changes have been shown to reflect systemic inflammation in vivo. We aimed to investigate whether retinal microvascular changes are correlated with, and predictive of, CD4 and CD8 cell count changes in patients with HIV/AIDS being treated with highly active antiretroviral therapy (HAART). Methods We did a longitudinal hospital-based study. 50 HIV/AIDS patients being treated with HAART were sequentially recruited from March, 2011, to September, 2011, from the Communicable Disease Center, Singapore, and then followed up at a 9 month visit. Demographic and socioeconomic information and history of HIV infection were collected at baseline. Blood pressure and anthropometric measurements, blood tests for immune status assessment (CD4 and CD8 cell counts), and retinal photography were done at baseline and at 9 months. Retinal vascular parameters (calibre, tortuosity, branching angle, and fractal dimension) were assessed by a semiautomated computer-based programme (Singapore I vessel assessment [SIVA], version 3.0, Singapore Eye Research Institute, Singapore). Changes of retinal vascular parameters and CD4 and CD8 cell counts were defined as the difference between baseline and 9 months. Findings The mean age of the 50 participants was 46·36 years (SD 8·67). Participants were ethnically Chinese, Malay, and Indian; most (82%) were Chinese and most male (96%). 35 of 50 patients had CD4 counts of fewer than 200 cells per μL at baseline. Years of HAART ranged from 0 to 11 years. There were significant increments in CD4 cell counts (153·42 vs 227·74 cells per μL; p vs 1014·1 cells per μL; p=0·012) between baseline and the 9 month visit, respectively. There were no temporal changes in retinal vascular parameters during this period. After adjustment for age, sex, ethnicity, and years of HAART, each 10 μm reduction in retinal venular calibre at baseline was associated with a 191·08 cells per μL increase in CD8 count (SE 63·54; p=0·004), but not in CD4 cell count, during the 9 month period. Changes of retinal arteriolar calibre and other retinal vascular geometric parameters were not associated with CD4 or CD8 cell count changes. Interpretation Retinal venular narrowing was associated with an increase in CD8 cell counts over time. Our findings suggest that improved retinal venular health was predictive of immune restoration in HIV/AIDS patients who had been on HAART for at least 9 months. Longer follow-up is warranted to monitor the retinal vascular calibre changes in response to HAART treatment. Funding Singapore Medical Research Counsel SIG/11016.