Loukia Tsierkezou’s research while affiliated with University of Manchester and other places

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 (26.8%) had significant lymphopenia (<1.0×10(9)/L), compared with 24/398 (6.0%) for other uveitis (p≤0.0001, OR 5.7 (95% CI 3.2 to 10.3)). The mean lymphocyte count for patients with SAU was 1.43 vs 2.04 for other uveitis (p≤0.0001). Logistic regression modelling using diagnosis of SAU as the independent variable identified age, ACE levels and lymphocyte count as independent predictors of SAU. A new patient with uveitis with significant lymphopenia has a risk of sarcoidosis (from this parameter alone) of 31.6%. Conclusions: Significant lymphopenia (<1.0×10(9)/L) is an independent predictor of sarcoidosis in new patients presenting with uveitis. We recommend that diagnostic criteria for SAU should be modified to include this phenomenon.

To report the outcomes of pars plana vitrectomy with epiretinal membrane (ERM) peel, with or without internal limiting membrane peel, in patients with uveitis. Retrospective interventional case series of patients undergoing pars plana vitrectomy with ERM peel between January 2005 and March 2012. Sixteen consecutive patients (16 eyes) were identified, with a minimum postoperative follow-up of 6 months. Visual acuity, anatomical outcomes, perioperative control of inflammation, and complications were assessed. The mean age at surgery was 47.3 years (range, 14-68 years), with a mean duration of ERM at surgery of 21.3 months (3-84 months). At 6 months, visual acuity improved in 31.25% of eyes, stabilized in 31.25%, and was worse in 37.5%. The causes of reduced visual acuity postoperatively included severe preexisting macular pathology and unoperated cataract. Pars plana vitrectomy with ERM peel in eyes with uveitis may improve or stabilize visual acuity, especially in eyes with macular traction, but in the absence of traction, outcomes are variable and unpredictable. Prevention of ERM formation by aggressive control of inflammation is important.

ERM +/- ILM peel in uveitis is a safe procedure but improves VA in only a minority with ERM with or without macular oedema. ILM peel may enhance outcomes (4 of 5 with improved VA underwent ILM peel, compared to 2 of 6 with reduced VA). Vitreomacular traction may respond particularly well with good anatomic success. Adequate peri-operative control of inflammation is essential. Cataract appears to be the most common cause of reduced vision in the initial postoperative period

Demographic studies on uveitis are substantially affected by the patient population and the MUC is no exception. The population is mostly indigenous white Caucasian with a substantial and increasing minority of those particularly from the Indian subcontinent but also from within the European Union, Eastern Europe and Africa. In this context some comparison can be made between population and clinic figures. Patients of Asian origin account for 6.5% of the GM population yet 13.1% of those attending MUC, and for black patients the figures are 1.7% and 6.8%, respectively (Tuberculosis and VKH is more common in Asians and sarcoidosis is more common in Asians and blacks).

We report a case of a metastatic cutaneous melanoma to the orbit. A 60-year-old Caucasian male presented with a 2-day history of left-sided ocular pain, lid swelling and chemosis. Initially, this was treated as conjunctivitis with no signs of improvement. Four days later, the patient developed left proptosis, mechanical ptosis, left esotropia and diplopia. Computed tomography scan of the orbit demonstrated marked thickening of the lateral rectus muscle. The patient was treated as pseudotumor. Subsequent biopsy revealed malignant cutaneous melanoma. The patient had a history of cutaneous melanoma excised 15 years previously. Further imaging showed advanced metastatic disease in the brain, the lung and the liver. The patient passed away five months after initial presentation. Cutaneous melanoma metastasizing to the orbit has poor prognosis. Patients often have advanced disease at the time of presentation and orbital metastases may be the initial sign. A detailed history is paramount in making timely diagnosis.