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Catastrophic Antiphospholipid Syndrome

Arbabi EM, Carrim ZI, Doherty MD, Vize CJ
Journal Paper Clinical & Experimental Ophthalmology, Volume 41, Issue 6, Pages 609–611, August 2013
PMID: 23278947 [PubMed - indexed for MEDLINE]

Entropion-ectropion: the influence of axial globe length on lower eyelid malposition.

Jyothi SB, Seddon J, Vize CJ
Journal Paper Ophthal Plast Reconstr Surg. 2012 May-Jun;28(3):199-203. doi: 10.1097/IOP.0b013e31824c86e7.
PMID: 22581083 [PubMed - indexed for MEDLINE]


Purpose: To evaluate the effect of axial globe length and other biometry parameters on age-related lower eyelid malposition.

METHODS: Consecutive patients with involutional lower eyelid malposition underwent preoperative biometry with Zeiss IOL Master and Hertel's exophthalmometer prior to surgery. Patients with other causes of eyelid malposition and thyroid eye disease were excluded. GraphPad InStat was used for t test and chi-square statistical analysis.

Results: Data on 57 eyelids of 52 Caucasian patients were collected. There were 28 ectropions and 29 entropions. The mean axial globe length in the ectropion group (23.5 mm, standard deviation ± 0.9) was significantly longer than in the entropion group (22.7 mm, standard deviation ± 1.03) (p = 0.008). There was significant sex predilection, with entropion more common in women and ectropion more common in men (p = 0.03). The mean axial globe projection in the ectropion group was 16.6 mm (standard deviation ± 2.4) and in the entropion group was 14.6 mm (standard deviation ± 2.7) (p = 0.002). There was no statistical difference in age, keratometry, amount of astigmatism, and cylinder axis.

Conclusion: Involutional eyelid malposition directly correlates with axial globe length with the ectropion group having lengthier eyes compared with the entropion group. Hence, axial globe length could be an influential factor in the onset of involutional eyelid malposition.

Punctoplasty with a Kelly punch.

Carrim ZI, Liolios VI, Vize CJ
Journal Paper Ophthal Plast Reconstr Surg. 2011 Sep-Oct;27(5):397-8. doi: 10.1097/IOP.0b013e31820367f3.
PMID: 21904183 [PubMed - indexed for MEDLINE]

Penetrating ocular trauma from trampoline spring.

Spokes D, Siddiqui S, Vize CJ
Journal Paper Orbit. 2010 Feb;29(1):39-41. doi: 10.3109/01676830903180330.
PMID: 20302409 [PubMed - indexed for MEDLINE]


The case is presented of a 12-year old boy who sustained severe penetrating ocular trauma while playing on a domestic trampoline. A main spring broke under tension and the hook had struck the eye at high velocity and penetrated the sclera. Primary repair was undertaken but on review it became apparent the eye could not be salvaged. Evisceration was carried out and an orbital implant was placed. Post-operative cosmesis is acceptable. This type of injury has not been reported before. Adult supervision of children on trampolines is recommended to minimise the chance of serious injury.

A novel use of intravitreal injection callipers.

Khan K, Vize CJ
Journal Paper Eye (Lond). 2009 Aug;23(8):1751. doi: 10.1038/eye.2008.327. Epub 2008 Nov 7.
PMID: 18989349 [PubMed - indexed for MEDLINE]

The practice of dacryocystorhinostomy (DCR) surgery by ophthalmologists in the United Kingdom (UK).

Gauba V, Islam T, Saleh GM, Zuberbuhler B, Vize CJ
Journal Paper Orbit. 2008;27(4):279-83. doi: 10.1080/01676830802224841. Erratum in: Orbit. 2008;27(5):395. Islam, Tahir [added]; Saleh, George M [added]; Zuberbuhler, Bruno [added]; Vize, Colin [added].
PMID: 18716965 [PubMed - indexed for MEDLINE]


Purpose: To study the practice of dacryocystorhinostomy (DCR) surgery by ophthalmologists in the United Kingdom (UK) looking at the evaluation techniques used, surgical variations, and follow-up management of DCR cases.

METHODS: A mail-shot questionnaire was designed and distributed to every UK consultant ophthalmologist on the specialist register held by the Royal College of Ophthalmologists. The questionnaire consisted of eight questions and an image of a typical DCR candidate so respondents could illustrate details of their surgical incision. The data received was entered into a database and analyzed with the SPSS statistical package. The variation in incisions was divided into various sub-types and quantified accordingly. The chi-square test and analysis of variance (ANOVA) were used to calculate significance, which was set at p < 0.05.

Results: A response rate of over 75% was achieved amongst the 800 questionnaires dispatched, almost one-third of which perform DCR surgery. Of these, almost 50% were non-lacrimal specialists. The majority never use the endonasal approach, with 59% never performing preoperative nasal endoscopy. Most respondents use a standard incision 10-15 mm long with routine silicone intubation. Lacrimal specialists tended to remove tubes earlier (week 4 to 8) and suture posterior flaps more often than non-specialists. Significant differences in practice were found between lacrimal and non-lacrimal specialists in most parameters, in addition to differences between members and non-members of the National Oculoplastic Surgery Society.

Conclusion: A minimum of 200 DCR surgeons are practicing in the UK where almost 50% are non-lacrimal specialists. Marked variations exist in the perioperative DCR practice.

Thiopurine methyltransferase screening before azathioprine therapy.

Gauba V, Saldanha M, Vize CJ, Saleh GM
Journal Paper Br J Ophthalmol. 2006 Jul;90(7):923-4.
PMID: 16782959 [PubMed - indexed for MEDLINE]

Radiological classification of anterior skull base anatomy prior to performing medial orbital wall decompression.

Gauba V, Saleh GM, Dua G, Agarwal S, Ell S, VIze CJ
Journal Paper Orbit. 2006 Jun;25(2):93-6.
PMID: 16754215 [PubMed - indexed for MEDLINE]


Purpose: To study a radiological classification, originally described by Keros in 1965, which provides an objective assessment of anterior skull base anatomy relevant in patients undergoing external medial orbital decompression.

Materials and Methods: The classification is based on anatomical landmarks measured via coronal CT-scan. The patients are divided into 3 Keros categories based on their olfactory fossa depth; Keros 1 (1-3 mm), Keros 2 (4-7 mm) and Keros 3 (8-16 mm). A cross-sectional group of 32 consecutive patients on the hospital radiology database with coronal CT scans were classified according to the Keros system.

Results: All the patients fell into one of the three Keros categories. Anatomical associations of the Keros classification suggest that Keros 1 patients have the least risk of intracranial entry whilst Keros 3 patients carry the greatest risk.

Conclusion: Keros classification provides an objective assessment of anterior skull base anatomy and can therefore guide the surgeon on the superior extent of medial wall bone removal during orbital decompression. This may help improve the safety profile of the procedure.

Eye injury as a result of coat toggle trauma.

Vize CJ, Gauba V, Atkinson PL.
Journal Paper Eye (Lond). 2007 Jan;21(1):94-5. Epub 2005 Nov 25.
PMID: 16311524 [PubMed - indexed for MEDLINE]


Purpose: To report the severity of ocular injury in three adults with blunt ocular trauma resulting from elastic corded coat toggles.

Design: Observational case series.

Methods: We retrospectively reviewed the case records of all patients (n=3) with blunt ocular trauma secondary to elastic corded coat toggles that presented to our department.

Results Injuries included traumatic hyphaema, cataract, angle recession, vitreous haemorrhage and retinal tears.

Conclusions: Significant ocular injury can result from elasticated coat toggles. The general ophthalmologist should be aware of this new method of potentially sight threatening trauma.

Spectrum, frequency and penetrance of OPA1 mutations in dominant optic atrophy.

Toomes C, Marchbank NJ, Mackey DA, Craig JE, Newbury-Ecob RA, Bennett CP,Vize CJ, Desai SP, Black GC, Patel N, Teimory M, Markham AF, Inglehearn CF, Churchill AJ.
Journal Paper Hum Mol Genet. 2001 Jun 15;10(13):1369-78.
PMID: 11440989 [PubMed - indexed for MEDLINE]


Dominant optic atrophy (DOA) is the commonest form of inherited optic neuropathy. Although heterogeneous, a major locus has been mapped to chromosome 3q28 and the gene responsible, OPA1, was recently identified. We therefore screened a panel of 35 DOA patients for mutations in OPA1. This revealed 14 novel mutations and a further three known mutations, which together accounted for 20 of the 35 families (57%) included in this study. This more than doubles the number of OPA1 mutations reported in the literature, bringing the total to 25. These are predominantly null mutations generating truncated proteins, strongly suggesting that the mechanism underlying DOA is haploinsufficiency. The mutations are largely family-specific, although a common 4 bp deletion in exon 27 (eight different families) and missense mutations in exons 8 (two families) and 9 (two families) have been identified. Haplotype analysis of individuals with the exon 27 2708del(TTAG) mutation suggests that this is a mutation hotspot and not an ancient mutation, thus excluding a major founder effect at the OPA1 locus. The mutation screening in this study also identified a number of asymptomatic individuals with OPA1 mutations. A re-calculation of the penetrance of this disorder within two of our families indicates figures as low as 43 and 62% associated with the 2708del(TTAG) mutation. If haploinsufficiency is the mechanism underlying DOA it is unlikely that this figure will be mutation-specific, indicating that the penetrance in DOA is much lower than the 98% reported previously. To investigate whether Leber's hereditary optic neuropathy (LHON) could be caused by mutations in OPA1 we also screened a panel of 28 LHON patients who tested negatively for the three major LHON mutations. No mutations were identified in any LHON patients, indicating that DOA and LHON are genetically distinct.

What factors influence cataract waiting list time?

Churchill AJ, Vize CJ, Stewart OG, Backhouse O.
Journal Paper Br J Ophthalmol. 2000 Apr;84(4):429-31.
PMID: 10729304 [PubMed - indexed for MEDLINE]


Aims: To determine whether there were any specific factors that influenced waiting list time (WLT) for patients undergoing cataract surgery.

Methods: 70 preoperative cataract patients were interviewed by one of the authors using a questionnaire to score visual acuity, coexisting ocular pathology and disabilities, threat to independent living/employment, and perceived visual handicap for detailed, gross, and driving vision. Individuals were analysed separately according to whether it was their first or second cataract operation.

Results: The median WLT for first eye surgery was 9 months (n = 31) and 13 months for second eye surgery (n = 36). The WLT ranged from 2 to 25 months for first eyes and 0.25-18 months for second eyes. Where there was a perceived threat to independent living or employment the WLT was found to be significantly shorter than the median. A high overall score correlated with a shorter WLT. Surgical priority was also given to individuals with anisometropia >3 dioptres.

Conclusion: This study has demonstrated that there are specific factors that influence clinicians when prioritising patients for cataract surgery.

Hypothalamic hamartomas causing gelastic epilepsy: two cases and a review of the literature.

Georgakoulias N, Vize CJ, Jenkins A, Singounas E.
Review Seizure. 1998 Apr;7(2):167-71.
PMID: 9627210 [PubMed - indexed for MEDLINE]


Two cases of hypothalamic hamartomas causing gelastic epilepsy are described. The clinical presentations and the radiological features are presented, and the mechanisms involved in laughing attacks are discussed. The literature is reviewed and it is suggested the complete extirpation of the hamartomas is the treatment of choice in gelastic epilepsy.

Severe reversible ocular anterior segment ischaemia following topical trifluorothymidine (F3T) treatment for herpes simplex keratouveitis.

Jayamanne DG, Vize CJ, , Ellerton CR, Morgan SJ, Gillie RF.
Journal Paper Eye (Lond). 1997;11 ( Pt 5):757-9.
PMID: 9474334 [PubMed - indexed for MEDLINE]