About
245
Publications
71,765
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
3,466
Citations
Introduction
Nicholas Jones is Honorary Professor of Ophthalmology, University of Manchester, UK. In 1991 he created the Manchester Uveitis Clinic, which became one of the busiest in the world. He retired from clinical practice in 2020. Main research interests are sarcoidosis and tuberculosis, imaging in uveitis, secondary glaucoma, and medical history. Jones is a member of the International Uveitis Study Group and a founder faculty member of the Moorfields and Euretina Uveitis Courses.
Skills and Expertise
Current institution
Additional affiliations
August 2015 - August 2020
March 1991 - August 2015
March 1991 - August 2020
Manchester University Hospitals NHS Foundation Trust
Position
- Consultant
Education
September 1978 - July 1981
September 1974 - June 1978
Publications
Publications (245)
Aims:
To investigate the hypothesis that lymphopenia is an independent predictor of sarcoidosis in new patients presenting with uveitis.
Patients and methods:
Retrospective case-control study of 112 patients with sarcoidosis-associated uveitis (SAU) against 398 controls with other forms of uveitis.
Results:
Of the patients with SAU, 30/112 (26...
Purpose: To assess the outcomes of intravitreal benzyl alcohol-free triamcinolone acetonide suspension in uveitis-related macular oedema.
Methods: Single-center retrospective cohort study of 66 injections to 44 eyes of 40 patients. Uveitis diagnosis, systemic and local therapy, intraocular pressure (IOP), central retinal thickness (CRT), number of...
Purpose: This study investigated the efficacy and safety of Baerveldt glaucoma implants (BGI) in adults with uveitic glaucoma (UG) at the Manchester Uveitis Clinic.
Methods: This was a retrospective study of 42 patients with UG who underwent BGI implantation between 2006 and 2015. Primary outcome measures were intraocular pressure (IOP) reduction a...
Purpose
To describe practical approaches to the management of subluxed or dislocated intraocular lenses (IOL) in patients with uveitis.
Patients and methods
Retrospective case series from a specialist uveitis clinic
Results
Fifteen IOLs in 13 patients were subluxed inferiorly (12) or dislocated into anterior chamber (2) or vitreous (1) at a me...
Precis:
The Xen-45 implant is an effective and safe treatment option for patients with medically uncontrolled glaucoma in the setting of uveitis, including those where urgent surgical intervention is required.
Purpose:
To report the efficacy and safety of the Xen-45 gel stent in eyes with glaucoma secondary to uveitis.
Methods:
Retrospective o...
Purpose:
To describe clinical outcomes in a large cohort with acute syphilitic posterior placoid chorioretinitis (ASPPC).
Methods:
Clinical records of patients with ASPPC, diagnosed between 2012 and 2023, were retrospectively reviewed. Confirmation of syphilis diagnosis required positive serological testing, except in human immunodeficiency viru...
MBBS, MS; Rupesh Agrawal, MMed, MD; for the Collaborative Ocular Tuberculosis Study (COTS) Group IMPORTANCE This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinica...
Investigations in uveitis: a rational approach
Acute Retinal necrosis in Immunocompetent Patients
Clinical, laboratory and imaging in the diagnosis of ocular sarcoidosis
Update on diagnosis and management of ocular tuberculosis
Sarcoidosis and Uveitis: diagnosis, complications and management
Clinical outcomes in patients with acute syphilitic posterior placoid chorioretinitis
The development of ophthalmology from oculist quackery to mainstream specialism in Manchester during the century 1750-1850
Aims:
To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide.
Methods:
A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices...
Aims:
To present current practice patterns in the diagnosis and management of Cytomegalovirus anterior uveitis (CMV AU) by uveitis experts worldwide.
Methods:
A two-round modified Delphi survey with masking of the study team was performed. Based on experience and expertise, 100 international uveitis specialists from 21 countries were invited to...
Decision-making and preparation for cataract surgery in patients with uveitis
Benjamin Gibson, a Newcastle-born surgeon, trained in Lancaster, Chester, London and Edinburgh before being appointed as assistant to Charles White, Manchester surgeon and man-midwife. He developed expertise in eye diseases, particularly of children. In 1804 he was appointed Honorary Surgeon to the Manchester Infirmary. He died young in 1812, but h...
Non-infectious uveitis (NIU) in children and adolescents is a rare but treatable cause of visual impairment in children. Treatments for pediatric NIU and their side effects, alongside the risks of vision loss and need for long-term disease monitoring, pose significant challenges for young patients and their families. Treatment includes local and sy...
The implications of uveitis presenting with granulomatous keratic precipitates on complications and outcome
An update on the current use of biologics in uveitis
Purpose:
To demonstrate changes in the demography and diagnosis of uveitis in a specialist clinic in the United Kingdom.
Methods:
Retrieval of data including all new referrals to Manchester Uveitis Clinic from 1991 to 2020. The incidence and proportions of diagnoses between 4 quartiles was compared.
Results:
5000 patients with uveitis were see...
Purpose: To present real-world adalimumab (ADA) efficacy and safety outcomes in non-infectious uveitis (NIU) from a single United Kingdom (UK) tertiary centre.
Methods: Retrospective review of adult patients with NIU treated with ADA. Data were collected at baseline, 6 and 12 months. The primary goal was to evaluate the rate of treatment failure, u...
Purpose: To describe and illustrate recent reclassification and clinical descriptions of the histiocytoses, diagnosis and management, and effects on the eye and adnexae
Patients and methods: Literature review with an illustrative case series of seven patients with histiocytosis and ophthalmic involvement from a single tertiary centre.
Results: Skin...
Aim: To present efficacy and safety of 0.19 mg fluocinolone acetonide insert (FAi) to treat chronic noninfectious uveitis (NIU) in a single referral center.
Methods: A retrospective observational clinical study of 11 eyes with NIU complicated by chronic cystoid macular edema (CMO).
Results: The main indication for treatment was chronic CMO in all 1...
Purpose: To provide recommendations for diagnosis of vitreoretinal lymphoma (VRL).
Methods: Literature was reviewed for reports supporting the diagnosis of VRL. A questionnaire (Delphi 1 round) was distributed to 28 participants. In the second round (Delphi 2), items of the questionnaire not reaching consensus (75% agreement) were discussed to fina...
Long-acting, slow-release injectable fluocinolone intravitreal implants have been approved for the treatment of non-infectious uveitis affecting the posterior segment. We summarise the development of intravitreal fluocinolone implants and discuss the technology including pharmacokinetics. We conducted a systematic review of evidence for the efficac...
Purpose: To identify the prevalence, risk factors and outcomes of avascular necrosis (AVN) in patients with chronic uveitis.
Methods: A retrospective study of patients with corticosteroid-induced AVN treated at Manchester Uveitis Clinic between 1991 and 2019.
Results: From a cohort of 4478 patients, 1698 had been treated with systemic corticosteroi...
Aims To establish expert recommendations for the management of ocular sarcoidosis (OS). Methods A question-based survey on the management of OS was circulated to international uveitis experts (members of the International Uveitis Study Group and the International Ocular Inflammation Society) electronically. Subsequently, a consensus workshop was co...
PURPOSE: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP. METHODS: Multicentre retrospecti...
Purpose: Tubercular intermediate uveitis (TIU) and panuveitis (TBP) are difficult to manage because of limitations in diagnostic tools and lack of evidence-based treatment guidelines. The Collaborative Ocular Tuberculosis Study (COTS) analyzed treatment regimens and therapeutic outcomes in patients with TIU and TBP.
Methods: Multicentre retrospecti...
Purpose
To report the detection of retinitis in the second eye of a patient with viral acute retinal necrosis (ARN), before the appearance of clinical change, using swept-source optical coherence tomography.
Results
A 63 year-old male developed right-sided varicella-zoster virus (VZV) ARN, confirmed with aqueous sampling. High-dose intravenous aci...
Purpose
To examine disease profile of tubercular uveitis (TBU) in Paediatric population.
Methods
Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed.
Results
Mean age of disease presentation was 12.8 (range 4–18 years), with pr...
Objective
Aim of the study was to examine extent, natural history, and clinical features associated with visual impairment (VI) in patients diagnosed with ocular tuberculosis (OTB) by the Collaborative Ocular Tuberculosis Study (COTS)-1.
Methods
Multi-center retrospective cohort study. Main outcomes were VI.
Results
A total of 302 patients were i...
Purpose
The Collaborative Ocular Tuberculosis Study (COTS) Group sought to address the diagnostic uncertainty through retrospective cohort analysis of treatment regimens and therapeutic outcomes for patients with tubercular Anterior Uveitis (TAU) across international centers.
Methods
Multicentre retrospective analysis of patients diagnosed with TA...
Purpose
To report the clinical findings, anatomical features, and treatment outcomes in subjects with ocular tuberculosis (OTB) at 24 months in the Collaborative Ocular Tuberculosis Study (COTS)-1.
Methods
Of the 945 subjects included in COTS-1, those who completed a 24-month follow-up after completion of treatment were included. The main outcome...
Data collection for the COTS-1 multicentre tuberculosis studies was facilitated by a cloud-based data aggregation platform with programmed logic based on anecdotal evidence from uveitis experts corroborated with literature review. The platform enabled standardization of interpretation and collection of data from patient medical
records. The pre-pro...
An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to oc...
An international, expert led consensus initiative was set up by the Collaborative Ocular Tuberculosis Study (COTS) group to develop systematic, evidence, and experience-based recommendations for the treatment of ocular TB using a modified Delphi technique process. In the first round of Delphi, the group identified clinical scenarios pertinent to oc...
Purpose
Automated measurement algorithm software is not routinely available in optical coherence tomography angiography (OCTA) devices and manual measurement of choroidal neovascular membrane (CNVM) size is necessary. Our aim was to determine intra- and inter-rater agreement of inflammatory CNVM manual measurements obtained with OCTA.
Methods
OCTA...
Purpose: To identify the prevalence, etiology, management and visual outcomes of treatment in uveitis-related corneal decompensation.
Patients and methods: This is a retrospective study of patients with corneal decompensation identified from a large cohort with uveitis in a tertiary referral clinic setting.
Results: Between March 1991 and May 2018,...
Background: Tuberculosis (TB) is a major infection that can affect the eye as first and sole presentation without features of systemic disease. Controversy exists regarding diagnosis and management of tubercular uveitis (TBU), further compounded by regional variations in disease expression. Purpose: Collaborative Ocular Tuberculosis Study (COTS)-1...
Background: Tuberculosis (TB) is a major infection that can affect the eye as first and sole presentation without features of systemic disease. Controversy exists regarding diagnosis and management of tubercular uveitis (TBU), further compounded by regional variations in disease expression. Purpose: Collaborative Ocular Tuberculosis Study (COTS)-1...
BACKGROUND`Tumour BACKGROUND` BACKGROUND`Tumour necrosis factor-alpha (TNF-α) is a key pro-inflammatory cytokine in non-infective uveitis (NIU) [1-2]. Adalimumab, an anti-TNF-α monoclonal antibody, was approved for use by NHS England (NHSE) and subsequently NICE (TA460) in 2017 for treatment of severe refractory NIU [3] .
Purpose: Cytomegalovirus retinitis (CMVR) is a serious and potentially sight-threatening infection in immunocompromised individuals. Strategies for the management of drug-resistant CMVR are described.
Methods: A case of severe bilateral CMVR in a single lung transplant patient, with UL97 mutation conferring ganciclovir-resistance, is presented. Tr...
Osteonecrosis is a rare but serious complication of corticosteroid therapy.
All patients receiving corticosteroid therapy are at risk of developing osteonecrosis regardless of total and daily corticosteroid dose.
Early diagnosis improves the prognosis and clinicians must remain vigilant for pain at typical sites (hip, knees, shoulders).
Major...
Purpose: To describe the antimicrobial effects of immunosuppressants used for presumed autoimmune uveitis, and to discuss the potential importance of these effects in the context of increasing knowledge of the human microbiomes and their influence on inflammation.
Methods: Literature review
Review of evidence: All immunosuppressants have intrinsic...
What is osteonecrosis (also known as avascular necrosis)?
Osteonecrosis involves progressive destruction of the bone due to disruption of blood supply leading to bone cell death and collapse of bone structure. It is a cause of significant pain and disability. The commonest sites are hips, shoulders and knees.
Corticosteroid use is a leading risk f...
An update on tuberculosis and syphilis in the uveitis clinic
Diagnosis and management of anterior uveitis
Managing cataract safely in the context of uveitis
Diagnosis and management of uveitis in children
Using clinical history and investigation to facilitate diagnosis in uveitis
Diagnosis and safe management of glaucoma in the context of uveitis
The present and future of uveitis treatment; modern developments and potential directions
Aims International criteria for the diagnosis of ocular sarcoidosis (OS) was established by the first International Workshop on Ocular Sarcoidosis (IWOS) and validations studies revealed certain limitations of the criteria. To overcome the limitations, revised IWOS criteria was established in an international meeting. This manuscript was aimed at r...
A presentation on the general principles of minimising inflammation in patients with uveitis for cataract surgery, followed by results of a questionnaire of IUSG members on their approaches to the problem.
Tumour necrosis factor-alpha (TNF-α) is a key proinflammatory cytokine in non-infective uveitis (NIU). Adalimumab, an anti-TNF-α monoclonal antibody, is approved for the treatment of severe NIU by the European Medicines Agency. There is a recognised risk of serious infections, including tuberculosis (TB), during anti-TNF-α therapy in systemic immun...
Overview of the most important ocular infections of posterior segment
Treat macular oedema early
Treat it aggressively enough to clear it
Tail off treatment and observe
Very long-standing oedema may be:
Structurally incapable of resolution with any treatment
Even if structurally resolved, VA may not improve
Repeated anti-VEGF is NOT adequate in the context of untreated uveitis
Oedema with VMT may require surgery (or...
A Walkden, L Fu, NP Jones, LR Steeples, Manchester Royal Eye Hospital, UK 22-year old female presented with acute vision loss during newly diagnosed, severe active SLE including skin lesions, CNS disease, arthropathy, digital vasculitis and nephropathy. Lupus autoantibodies +ve: ANA, dsDNA, chromatin & ribosomal P, ESR 65, depleted complement (C3,C...
Using pattern recognition of clinical presentations to suspect the diagnosis of intraocular lymphoma
Surgical management of Uveitic Glaucoma is challenging
Often patients have hypertensive crises which needs urgent intervention
The XEN-45 implant is an effective treatment
Dramatic lowering of IOP without significant uveitic flare up
6-12 month success established with lower needling rates than POAG
Sight threatening complications including h...
Background:
Primary vitreoretinal lymphoma (PVRL) is a rare ocular condition and its diagnosis remains a challenge. The clinical presentation is variable and it can masquerade as chronic intermediate or posterior uveitis. We report an unusual case of primary central nervous system lymphoma (PCNSL) presenting as migrating retinal lesions with uniqu...
Purpose:
To contribute a global description of the spectrum of choroidal involvement in tubercular uveitis (TBU).
Methods:
Retrospective cohort study of TBU patients with choroidal involvement from 25 centers between January 2004 and December 2014. Medical records of patients with a minimum follow-up of 1 year were reviewed.
Results:
245 patie...
Purpose: To evaluate multimodal imaging findings in longitudinal follow-up of a patient with presumed tuberculous serpiginous-like choroiditis (TB-SLC).
Method: We evaluated multimodal imaging in a 62-year-old male with TB-SLC. Correlation between optical coherence tomography angiography (OCTA), swept-source OCT (SS-OCT) and fundus autofluorescence...
Background/aims
To investigate the incidence, management and outcome of uveitis and raised intraocular pressure (IOP) in children treated at the Manchester Uveitis Clinic (MUC).
Methods
This was a retrospective, observational study of patients who presented with uveitis under the age of 16 to the MUC from July 2002 to June 2016.
Results
A total o...
Sarcoidosis is a multisystem disease of unknown aetiology with pulmonary involvement in most patients. Uveitis is common and often characteristic. We report a case of ocular sarcoidosis with grossly atypical contiguous optic neuropathy and choroiditis and describe the diagnostic challenges in this highly unusual presentation. High-dose systemic cor...
A 4-year-old girl presented with acute left visual loss 4 weeks after uneventful chickenpox. She was found to have left necrotising retinitis and profound retinal vasculitis and vitritis. Aqueous humour was PCR positive for varicella-zoster virus. Combined intravenous and intravitreal antiviral treatment led to rapid improvement with settled retini...
Purpose: To identify the causes of severe visual loss in a UK uveitis clinic, to suggest means of reducing incidence, and to propose improvement in data collection of vision impairment.
Patients and methods: Retrospective case series.
Results: Over 128 months, 76 (3.5–4% of patients referred) were certified as vision-impaired or severely vision-imp...
Purpose:
To analyze the role of polymerase chain reaction (PCR) of ocular fluids in management of tubercular (TB) anterior, intermediate, posterior, and panuveitis.
Methods:
In Collaborative Ocular Tuberculosis Study (COTS)-1 (25 centers, n = 962), patients with TB-related uveitis were included. 59 patients undergoing PCR of intraocular fluids (...
MS; for the Collaborative Ocular Tuberculosis Study (COTS)-1 Study Group IMPORTANCE Eradication of systemic tuberculosis (TB) has been limited by neglected populations and the HIV pandemic. Whereas ocular TB often presents as uveitis without any prior evidence of systemic TB, the existing uncertainty in the diagnosis of TB uveitis may perpetuate mi...
Ocular hypertension and glaucoma are frequent complications in childhood-onset uveitis and remains one of the major causes of visual loss in this group. In 1984 one third of children with uveitis and glaucoma became blind.1 In contrast, a 2006 study found an incidence of 7%,2 which may in part be explained by improved management. The aim of this st...
Each passing year identifies new characteristics of the immunogenetics and pathogenesis of the disease, yet the causes remain elusive. It has become clear that possible initiating antigens are numerous, each with its claim to authenticity, and that genetic predisposition is complex, polymorphic, variable between races and of low heritability. The a...
This lecture will present developments in ocular sarcoidosis diagnosis including new IWOS criteria, new targets for haematological diagnosis, EBUS-TBNA, existing immunosuppressive and biologic treatment, and potential new targets for treatment
We report imaging findings in a patient with presumed tuberculous serpiginous-like choroiditis (TB-SLC) and present findings in active, progressive disease and subsequent stabilisation and transition to inactive disease following systemic corticosteroid and anti-TB therapy
