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Verma R, Chen AJ, Choi D, Wilson DJ, Grossniklaus HE, Dailey RA, Ng JD, Steele EA, Planck SR, Czyz CN, Korn BS, Kikkawa DO, Foster JA, Kazim M, Harris GJ, Edward DP, Al Maktabi A, Rosenbaum JT. Inflammation and Fibrosis in Orbital Inflammatory Disease: A Histopathologic Analysis. Ophthalmic Plast Reconstr Surg 2023; 39:588-593. [PMID: 37279012 PMCID: PMC10698206 DOI: 10.1097/iop.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The purpose of this study was to compare the histopathologic inflammation and fibrosis of orbital adipose tissue in orbital inflammatory disease (OID) specimens. METHODS In this retrospective cohort study, inflammation, and fibrosis in orbital adipose tissue from patients with thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis, nonspecific orbital inflammation (NSOI), and healthy controls were scored by 2 masked ocular pathologists. Both categories were scored on a scale of 0 to 3 with scoring criteria based on the percentage of specimens containing inflammation or fibrosis, respectively. Tissue specimens were collected from oculoplastic surgeons at 8 international centers representing 4 countries. Seventy-four specimens were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 24 with NSOI, and 12 healthy controls. RESULTS The mean inflammation and fibrosis scores for healthy controls were 0.0 and 1.1, respectively. Orbital inflammatory disease groups' inflammation (I) and fibrosis (F) scores, formatted [I, F] with respective p -values when compared to controls, were: TAO [0.2, 1.4] ( p = 1, 1), GPA [1.9, 2.6] ( p = 0.003, 0.009), sarcoidosis [2.4, 1.9] ( p = 0.001, 0.023), and NSOI [1.3, 1.8] ( p ≤ 0.001, 0.018). Sarcoidosis had the highest mean inflammation score. The pairwise analysis demonstrated that sarcoidosis had a significantly higher mean inflammation score than NSOI ( p = 0.036) and TAO ( p < 0.0001), but no difference when compared to GPA. GPA had the highest mean fibrosis score, with pairwise analysis demonstrating a significantly higher mean fibrosis score than TAO ( p = 0.048). CONCLUSIONS Mean inflammation and fibrosis scores in TAO orbital adipose tissue samples did not differ from healthy controls. In contrast, the more "intense" inflammatory diseases such as GPA, sarcoidosis, and NSOI did demonstrate higher histopathologic inflammation and fibrosis. This has implications in prognosis, therapeutic selection, and response monitoring in orbital inflammatory disease.
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Affiliation(s)
- Rohan Verma
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison J. Chen
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
| | - Dongseok Choi
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Wilson
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Roger A Dailey
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - John D. Ng
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric A. Steele
- Oculofacial Plastic and Reconstructive Surgery, Casey Aesthetic Facial Surgery Center, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen R. Planck
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
| | - Craig N. Czyz
- Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth, Columbus, Ohio, USA
| | - Bobby S. Korn
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
- Plastic Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Don O. Kikkawa
- Oculofacial Plastic and Reconstructive Surgery, University of California San Diego- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, La Jolla, California, USA
- Plastic Surgery, University of California San Diego, La Jolla, California, U.S.A
| | - Jill A. Foster
- Oculofacial Plastic and Reconstructive Surgery, Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA
| | - Michael Kazim
- Oculofacial Plastic and Reconstructive Surgery, Edward S Harkness Eye Institute, Columbia University, New York, New York, USA
| | - Gerald J. Harris
- Oculofacial Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deepak P. Edward
- Ophthalmology, University of Illinois College of Medicine, Chicago, Illinois, USA
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - James T. Rosenbaum
- Ophthalmology Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Ophthalmology Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
- Corvus Pharmaceuticals Inc., Burlingame, CA 94010, USA
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Zhou X, Wei R, Wang R. Characterization of human tear proteome reveals differentially abundance proteins in thyroid-associated ophthalmopathy. PeerJ 2022; 10:e13701. [PMID: 35846879 PMCID: PMC9285480 DOI: 10.7717/peerj.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Thyroid-associated ophthalmopathy (TAO) is a common orbital inflammatory disease, but the abnormal expression of proteins in tears of TAO patients has not been systematically studied. The purpose of this study is to compare and analyze the total tear protein profile of TAO patients and to provide protein cues for TAO pathogenesis. Methods Tear samples were isolated from 30 TAO patients with obvious ocular surface damage and 30 healthy control subjects. Tear samples from 30 individuals were mixed and divided into three sample pools. Easy nano-scale LC-MS/MS based on labeling-free quantitative technology was utilized to profile tear proteome. Results Here, electrospray ionization mass spectra and SDS-PAGE results confirmed the good parallelisms among samples. A total of 313 proteins were obtained from six tear pools, among them, 103 differential abundance proteins (DAPs) were identified, including 99 up-regulated DAPs (including APOA1, HV103, IGH, and Transferrin variant) and four down-regulated DAPs (including FABA, VCC1, NUCB2, and E-cadherin) in the TAO group compared with the control group. GO analysis showed that up-regulated DAPs were mainly enriched in lipid metabolism and platelet molecular function, and down-regulated DAPs were involved in binding, cell junction, and cellular process. KEGG results indicated that DAPs were involved in 117 kinds of signal transduction pathways, among which the immune-related pathway of complement and coagulation cascades had the greatest relevance. Conclusion In conclusion, label-free LC-MS/MS is an effective strategy for profiling tear proteins component. Our study provides proteins and pathways altered in TAO and provides protein cues for further study on the precise mechanism of TAO pathogenesis.
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Affiliation(s)
- Xiaoqing Zhou
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, Shanghai, China
| | - Rui Wang
- Proteome Research Cente, Shanghai Applied Protein Technology, Shanghai, Shanghai, China
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Li J, Chen F, Huang G, Zhang S, Wang W, Tang Y, Chu Y, Yao J, Guo L, Jiang F. Identification of Graves' ophthalmology by laser-induced breakdown spectroscopy combined with machine learning method. FRONTIERS OF OPTOELECTRONICS 2021; 14:321-328. [PMID: 36637721 PMCID: PMC9743923 DOI: 10.1007/s12200-020-0978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/04/2020] [Indexed: 06/17/2023]
Abstract
Diagnosis of the Graves' ophthalmology remains a significant challenge. We identified between Graves' ophthalmology tissues and healthy controls by using laser-induced breakdown spectroscopy (LIBS) combined with machine learning method. In this work, the paraffin-embedded samples of the Graves' ophthalmology were prepared for LIBS spectra acquisition. The metallic elements (Na, K, Al, Ca), non-metallic element (O) and molecular bands ((C-N), (C-O)) were selected for diagnosing Graves' ophthalmology. The selected spectral lines were inputted into the supervised classification methods including linear discriminant analysis (LDA), support vector machine (SVM), k-nearest neighbor (kNN), and generalized regression neural network (GRNN), respectively. The results showed that the predicted accuracy rates of LDA, SVM, kNN, GRNN were 76.33%, 96.28%, 96.56%, and 96.33%, respectively. The sensitivity of four models were 75.89%, 93.78%, 96.78%, and 96.67%, respectively. The specificity of four models were 76.78%, 98.78%, 96.33%, and 96.00%, respectively. This demonstrated that LIBS assisted with a nonlinear model can be used to identify Graves' ophthalmopathy with a higher rate of accuracy. The kNN had the best performance by comparing the three nonlinear models. Therefore, LIBS combined with machine learning method can be an effective way to discriminate Graves' ophthalmology.
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Affiliation(s)
- Jingjing Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Feng Chen
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Guangqian Huang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Siyu Zhang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Weiliang Wang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yun Tang
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yanwu Chu
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jian Yao
- School of Remote Sensing and Information Engineering, Wuhan University, Wuhan, 430079, China
| | - Lianbo Guo
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China.
| | - Fagang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Wang N, Hou SY, Qi X, Deng M, Cao JM, Tong BD, Xiong W. LncRNA LPAL2/miR-1287-5p/EGFR Axis Modulates TED-Derived Orbital Fibroblast Activation Through Cell Adhesion Factors. J Clin Endocrinol Metab 2021; 106:e2866-e2886. [PMID: 33877318 DOI: 10.1210/clinem/dgab256] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The activation of orbital fibroblasts, the prime targets in thyroid eye disease (TED), is central to its underlying pathogenesis. OBJECTIVE We aimed to investigate the mechanism of TED orbital fibroblast activation from the perspective of noncoding RNA regulation. METHODS Immunofluorescence (IF) staining was applied to evaluate the fibrotic changes in target cells. Cell proliferation was evaluated by 5-ethoxy 2-deoxyuridine and colony-formation assays. Collagen I concentration was determined by enzyme-linked immunosorbent assay. Human microarray analysis was performed on 3 TED and 3 healthy control orbital tissue samples. RESULTS Bioinformatics analysis showed that cell adhesion signaling factors were differentially expressed in TED tissues, including intercellular adhesion molecule (ICAM)-1, ICAM-4, vascular cell adhesion molecule, and CD44, which were all upregulated in diseased orbital tissues. Long noncoding RNA LPAL2 level was also upregulated in orbital tissues and positively correlated with ICAM-1 and ICAM-4 expression. Stimulation of the TED orbital fibroblasts by transforming growth factor-β1 (TGF-β1) significantly increased the expression of ICAM-1, ICAM-4, and LPAL2. Knockdown of LPAL2 in orbital fibroblasts inhibited TGF-β1-induced increases in cell adhesion factor levels and orbital fibroblast activation. Microarray profiling was performed on TED and normal orbital tissues to identify differentially expressed microRNAs, and miR-1287-5p was remarkably reduced within diseased orbital samples. miR-1287-5p was directly bound to the epidermal growth factor receptor (EGFR) 3' untranslated region and LPAL2, and LPAL2 modulated EGFR/protein kinase B (AKT) signaling through targeting miR-1287-5p. CONCLUSION The LPAL2/miR-1287-5p axis modulated TGF-β1-induced increases in cell adhesion factor levels and TED orbital fibroblast activation through EGFR/AKT signaling.
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Affiliation(s)
- Nuo Wang
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Shi-Ying Hou
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Xin Qi
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Mi Deng
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Jia-Min Cao
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Bo-Ding Tong
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan,China
| | - Wei Xiong
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan,China
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Arenas M, Sabater S, Jiménez PL, Rovirosa À, Biete A, Linares V, Belles M, Panés J. Radiotherapy for Graves' disease. The possible role of low-dose radiotherapy. Rep Pract Oncol Radiother 2016; 21:213-8. [PMID: 27601953 DOI: 10.1016/j.rpor.2016.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022] Open
Abstract
Immunomodulatory effects of low-dose radiotherapy (LD-RT) have been used for the treatment of several benign diseases, including arthrodegenerative and inflammatory pathologies. Graves' disease is an autoimmune disease and radiotherapy (RT) is a therapeutic option for ocular complications. The dose recommended in the clinical practice is 20 Gy (2 Gy/day). We hypothesized that lower doses (<10 Gy total dose, <1 Gy/day) could results in higher efficacy if we achieved anti-inflammatory and immunomodulatory effects of LD-RT. We review current evidence on the effects of RT in the treatment of Graves' disease and the possible use of LD-RT treatment strategy.
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Affiliation(s)
- Meritxell Arenas
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Sebastià Sabater
- Radiation Oncology Department, Complejo Hospitalario Universitario Albacete (CHUA), Spain
| | - Pedro Lara Jiménez
- Radiation Oncology Department, Hospital Universitario Dr Negrín, Universidad Las Palmas de Gran Canaria (LPGC), Las Palmas de Gran Canaria, Spain
| | - Àngels Rovirosa
- Radiation Oncology Department, Hospital Universitari Clínic de Barcelona, Spain
| | - Albert Biete
- Radiation Oncology Department, Hospital Universitari Clínic de Barcelona, Spain
| | - Victoria Linares
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, URV, Reus, Spain
| | - Montse Belles
- Laboratory of Toxicology and Environmental Health, School of Medicine, IISPV, URV, Reus, Spain
| | - Julià Panés
- Gastroenterology Department, Hospital Universitari Clínic de Barcelona, Spain
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Choi SU, Kim KW, Lee JK. Surgical Outcomes of Balanced Deep Lateral and Medial Orbital Wall Decompression in Korean Population: Clinical and Computed Tomography-based Analysis. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:85-91. [PMID: 27051255 PMCID: PMC4820530 DOI: 10.3341/kjo.2016.30.2.85] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the clinical outcomes of balanced deep lateral and medial orbital wall decompression and to estimate surgical effects using computed tomography (CT) images in Korean patients with thyroid-associated ophthalmopathy (TAO). Methods Retrospective chart review was conducted in TAO patients with exophthalmos who underwent balanced deep lateral and medial orbital wall decompression. Exophthalmos was measured preoperatively and postoperatively at 1 and 3 months. Postoperative complications were evaluated in all study periods. In addition, decompressed bone volume was estimated using CT images. Thereafter, decompression volume in each decompressed orbital wall was analyzed to evaluate the surgical effect and predictability. Results Twenty-four patients (48 orbits) with an average age of 34.08 ± 7.03 years were evaluated. The mean preoperative and postoperative exophthalmos at 1 and 3 months was 18.91 ± 1.43, 15.10 ± 1.53, and 14.91 ± 1.49 mm, respectively. Bony decompression volume was 0.80 ± 0.29 cm3 at the medial wall and 0.68 ± 0.23 cm3 at the deep lateral wall. Postoperative complications included strabismus (one patient, 2.08%), upper eyelid fold change (four patients, 8.33%), and dysesthesia (four patients, 8.33%). Postsurgical exophthalmos reduction was more highly correlated with the deep lateral wall than the medial wall. Conclusions In TAO patients with exophthalmos, balanced deep lateral and medial orbital wall decompression is a good surgical method with a low-risk of complications. In addition, deep lateral wall decompression has higher surgical predictability than medial wall decompression, as seen with CT analysis.
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Affiliation(s)
- Sang Uk Choi
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Woo Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Chemodenervation of extraocular muscles with botulinum toxin in thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 2016; 254:999-1003. [DOI: 10.1007/s00417-016-3281-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 12/09/2015] [Accepted: 01/25/2016] [Indexed: 01/03/2023] Open
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Kim SA, Jung SK, Paik JS, Yang SW. Effect of Orbital Decompression on Corneal Topography in Patients with Thyroid Ophthalmopathy. PLoS One 2015; 10:e0133612. [PMID: 26352432 PMCID: PMC4564163 DOI: 10.1371/journal.pone.0133612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate changes in corneal astigmatism in patients undergoing orbital decompression surgery. Methods This retrospective, non randomized comparative study involved 42 eyes from 21 patients with thyroid ophthalmopathy who underwent orbital decompression surgery between September 2011 and September 2014. The 42 eyes were divided into three groups: control (9 eyes), two-wall decompression (25 eyes), and three-wall decompression (8 eyes). The control group was defined as the contralateral eyes of nine patients who underwent orbital decompression surgery in only one eye. Corneal topography (Orbscan II), Hertel exophthalmometry, and intraocular pressure were measured at 1 month before and 3 months after surgery. Corneal topographic parameters analyzed were total astigmatism (TA), steepest axis (SA), central corneal thickness (CCT), and anterior chamber depth (ACD). Results Exophthalmometry values and intraocular pressure decreased significantly after the decompression surgery. The change (absolute value (|x|) of the difference) in astigmatism at the 3 mm zone was significantly different between the decompression group and the controls (p = 0.025). There was also a significant change in the steepest axis at the 3 mm zone between the decompression group and the controls (p = 0.033). An analysis of relevant changes in astigmatism showed that there was a dominant tendency for incyclotorsion of the steepest axis in eyes that underwent decompression surgery. Using Astig PLOT, the mean surgically induced astigmatism (SIA) was 0.21±0.88 D with an axis of 46±22°, suggesting that decompression surgery did change the corneal shape and induced incyclotorsion of the steepest axis. Conclusions There was a significant change in corneal astigmatism after orbital decompression surgery and this change was sufficient to affect the optical function of the cornea. Surgeons and patients should be aware of these changes.
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Affiliation(s)
- Su Ah Kim
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Kyung Jung
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Sun Paik
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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10
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Markers of inflammation and fibrosis in the orbital fat/connective tissue of patients with Graves' orbitopathy: clinical implications. Mediators Inflamm 2014; 2014:412158. [PMID: 25309050 PMCID: PMC4182072 DOI: 10.1155/2014/412158] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. To assess FGF-β, TGF-β, and COX2 expression and immunocompetent cells in the orbital tissue of patients with severe and mild Graves' orbitopathy. Patients and Methods. Orbital tissue was taken from 27 patients with GO: (1) severe GO (n = 18), the mean clinical activity score (CAS) being 8.5 (SD 2.5); and (2) mild GO (n = 9), the mean CAS being 2.2 (SD 0.8), and from 10 individuals undergoing blepharoplasty. The expression of CD4+, CD8+, CD20+, and CD68 and FGF-β, TGF-β, and COX2 in the orbital tissue was evaluated by immunohistochemical methods. Results. We demonstrated predominant CD4+ T cells in severe GO. CD68 expression was observed in the fibrous connective area of mild GO and was robust in severe GO, while the prominent TGF-β expression was seen in all GO. Increased FGF-β expression was observed in the fibroblasts and adipocytes of severe GO. No expression of COX2 was found in patients with GO. Conclusions. Macrophages and CD4 T lymphocytes are both engaged in the active/severe and long stage of inflammation in the orbital tissue. FGF-β and TGF-β expression may contribute to tissue remodeling, fibrosis, and perpetuation of inflammation in the orbital tissue of GO especially in severe GO.
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Chen ML, Liao N, Zhao H, Huang J, Xie ZF. Association between the IL1B (-511), IL1B (+3954), IL1RN (VNTR) polymorphisms and Graves' disease risk: a meta-analysis of 11 case-control studies. PLoS One 2014; 9:e86077. [PMID: 24465880 PMCID: PMC3897612 DOI: 10.1371/journal.pone.0086077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 12/04/2013] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Data on the association between the interleukin-1 (IL-1) gene polymorphisms and Graves' disease (GD) risk were conflicting. A meta-analysis was undertaken to assess this association. METHODS We searched for case-control studies investigating the association between the IL1B (-511), IL1B (+3954), IL1RN (VNTR) polymorphisms and GD risk. We extracted data using standardized forms and calculated odds ratios (OR) with 95% confidence intervals (CI). RESULTS A total of 11 case-control studies were included in this meta-analysis. Available data indicated that the IL1B (-511) polymorphism was associated with GD risk in the overall populations (Caucasians and Asians) in homozygote model (TT vs. CC, OR = 0.86, 95% CI: 0.76-0.97, Pz = 0.015), but not in dominant and recessive models (TT+TC vs. CC: OR = 0.95, 95% CI: 0.81-1.12, Pz = 0.553 and TT vs. TC+CC: OR = 0.82, 95% CI: 0.60-1.12, Pz = 0.205, respectively). No association between the IL1B (+3954), IL1RN (VNTR) polymorphisms and GD risk was found in the overall populations in any of the genetic models. In subgroup analyses according to ethnicity, the IL1B (-511) polymorphism was associated with GD risk in Asians in recessive and homozygote models (TT vs. TC+CC: OR = 0.68, 95% CI: 0.55-0.84, Pz < 0.001 and TT vs. CC: OR = 0.81, 95% CI: 0.70-0.93, Pz = 0.003, respectively), but not in dominant model (TT+TC vs. CC: OR = 0.92, 95% CI: 0.77-1.11, Pz = 0.389). No association between the IL1B (+3954), IL1RN (VNTR) polymorphisms and GD risk was indicated in Asians, and we found no association between the IL1B (-511), IL1B (+3954), IL1RN (VNTR) polymorphisms and GD risk in Caucasians in any of the genetic models. CONCLUSION The IL1B (-511) polymorphism, but not the IL1B (+3954) and IL1RN (VNTR) polymorphisms was associated with GD risk in Asians. There was no association between these polymorphisms and GD risk in Caucasians.
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Affiliation(s)
- Min-Li Chen
- Department of Geriatrics and Gerontology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Ning Liao
- Department of Geriatrics and Gerontology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Hua Zhao
- Department of Geriatrics and Gerontology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Jian Huang
- Department of Clinical Medicine, Grade 2001, Guangxi Medical University, Nanning, China
| | - Zheng-Fu Xie
- Department of Geriatrics and Gerontology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Zhao P, Deng Y, Gu P, Wang Y, Zhou H, Hu Y, Chen P, Fan X. Insulin-like growth factor 1 promotes the proliferation and adipogenesis of orbital adipose-derived stromal cells in thyroid-associated ophthalmopathy. Exp Eye Res 2012; 107:65-73. [PMID: 23219871 DOI: 10.1016/j.exer.2012.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/23/2012] [Accepted: 11/26/2012] [Indexed: 12/20/2022]
Abstract
Thyroid-associated ophthalmopathy (TAO) is characterised by increased volume of the orbital contents involving adipose tissue, but the factors responsible for stimulation of orbital adipogenesis remain uncertain. Previous studies have shown that insulin-like growth factor 1 (IGF-1) is increased in the orbital fatty connective tissues of patients with TAO. The present study was conducted to investigate the effects of IGF-1 on orbital adipose-derived stromal cells (OADSCs) derived from TAO patients and to identify the signalling mechanisms involved. Our results showed that IGF-1 significantly promoted the cell proliferation and lipid accumulation of TAO OADSCs. The mRNA expression of adipogenic markers (adiponectin, leptin, adipocyte fatty acid binding protein [AP2] and fatty acid synthase [FAS]) was increased in TAO cultures treated with IGF-1. Further research demonstrated that the protein levels of peroxisome proliferator-activated receptor-γ (PPARγ) were up-regulated when OADSCs were treated with IGF-1. We also found that the inhibition of either IGF-1 receptor (IGF-1R) or phosphoinositide 3-kinase (PI3K) activity decreased the levels of IGF-1-stimulated mRNA encoding adiponectin, leptin, AP2, and FAS, as well as PPARγ protein levels. Moreover, the expression of phosphorylated Akt (p-Akt) protein in TAO cells was up-regulated by IGF-1, while a specific PI3K inhibitor (LY294002) or an antibody of IGF-1R blocked this effect. These results indicate that IGF-1 is a pro-proliferative and pro-adipogenic factor in TAO OADSCs. IGF-1 enhances the adipogenesis of TAO OADSCs by up-regulation of PPARγ via the activation of the IGF-1R and PI3K pathways, suggesting that the blocking of IGF-1R or inhibition of PI3K signalling might be a potential novel therapeutic approach to TAO.
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Affiliation(s)
- Pingqian Zhao
- Department of Ophthalmology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhizaoju Road, Shanghai 200011, China
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13
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Abstract
Although the diagnosis of Graves' orbitopathy is primarily made clinically based on laboratory tests indicative of thyroid dysfunction and autoimmunity, imaging studies, such as computed tomography, magnetic resonance imaging, ultrasound and color Doppler imaging, play an important role both in the diagnosis and follow-up after clinical or surgical treatment of the disease. Imaging studies can be used to evaluate morphological abnormalities of the orbital structures during the diagnostic workup when a differential diagnosis versus other orbital diseases is needed. Imaging may also be useful to distinguish the inflammatory early stage from the inactive stage of the disease. Finally, imaging studies can be of great help in identifying patients prone to develop dysthyroid optic neuropathy and therefore enabling the timely diagnosis and treatment of the condition, avoiding permanent visual loss. In this paper, we review the imaging modalities that aid in the diagnosis and management of Graves' orbitopathy, with special emphasis on the diagnosis of optic nerve dysfunction in this condition.
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Affiliation(s)
- Allan C Pieroni Gonçalves
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Ophthalmology, São Paulo, SP, Brazil.
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14
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Akarsu E, Buyukhatipoglu H, Aktaran S, Kurtul N. Effects of pulse methylprednisolone and oral methylprednisolone treatments on serum levels of oxidative stress markers in Graves' ophthalmopathy. Clin Endocrinol (Oxf) 2011; 74:118-24. [PMID: 21044110 DOI: 10.1111/j.1365-2265.2010.03904.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent evidence has shown that oxidative stress may play a role in the pathogenesis of autoimmune diseases, and this is an issue of considerable research interest in the field of infiltrative ophthalmopathy. Therefore, we evaluated both the relationship between Graves' ophthalmopathy (GO) and serum levels of certain indicators of oxidative stress, and the effects of methylprednisolone treatment on serum malondialdehyde (MDA) and glutathione (GSH) levels in patients with euthyroid GO. MATERIALS AND METHODS We compared GO patients to both Graves' patients without ophthalmopathy and healthy controls. Ultimately, we assessed four subject groups. Graves' patients with ophthalmopathy (GO) were subcategorized into two groups: Group A subjects (n = 18) were given intravenous glucocorticoid and Group B patients (n = 15) were given oral glucocorticoid. Graves' patients without ophthalmopathy comprised Group C (n = 20), and healthy controls comprised Group D (n = 15). Serum levels of MDA and GSH were measured at baseline and after 4 and 24 weeks of observation via spectrophotometric methods. RESULTS We found that serum MDA levels were significantly higher in the two GO groups (Groups A and B) than in GO patients without ophthalmopathy or healthy controls. Conversely, GSH levels were significantly lower in the two GO groups than in Groups C and D. MDA and GSH levels were not different between the latter two groups. MDA levels were strongly and positively correlated with a clinical activity score (CAS). In Group A, MDA levels and the CAS were significantly lower than in Group B at 4 weeks. After 24 weeks, however, MDA levels and the CAS were similar in these two groups. CONCLUSION Oxidative stress appears to be involved in the pathophysiology of GO. Relative to oral dosing, the intravenous administration of a glucocorticoid seems to yield more rapid improvement in disease activity. MDA might be useful as an indicator of clinical activity.
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Affiliation(s)
- Ersin Akarsu
- Department of Endocrinology, Gaziantep University School of Medicine, Turkey
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15
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Mensah A, Vignal-Clermont C, Mehanna C, Morel X, Galatoire O, Jacomet PV, Morax S. Dysthyroid optic neuropathy: atypical initial presentation and persistent visual loss. Orbit 2010; 28:354-62. [PMID: 19929659 DOI: 10.3109/01676830903104728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Dysthyroid Optic Neuropathy (DON) can lead to irreversible visual loss. We report risk features correlated with poor visual recovery despite an intensive treatment in a series of patients with DON. DESIGN Retrospective analysis of a non-comparative interventional series. METHODS Between 1997 and 2007, 300 consecutive patients with Graves' orbitopathy were seen at the Rothschild Foundation (Paris). Medical records of all consecutive patients who developed a DON were reviewed. Demographic, clinical features and visual function were collected at the time of the first onset, one month follow-up after medical and sometime surgical treatment and at the last examination. Statistical analysis (reflected as p values) gathered the significant observations into detrimental visual recovery prognostic factors for DON. RESULTS Fifty-six eyes of 29 patients developed a DON. Sixteen eyes (28%) did not improve vision despite usual treatment (intravenous steroids and surgical decompression when necessary). An inferior altitudinal visual field defect (AVF, p=0.0004) and/or a lack of response to intravenous steroids boluses (p= 0.011) were related to a poor recovery. CONCLUSION DON prognosis is highly variable. Our results suggest that a non-inflammatory element, probably vascular could be involved in atypical DONs. An earlier recognition could prompt to rapid surgical treatment for these patients.
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Affiliation(s)
- Aurore Mensah
- Oculoplastics and Neuro-Ophthalmology department of Rothschild Eye Foundation of Paris, France.
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16
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Khalilzadeh O, Anvari M, Esteghamati A, Mahmoudi M, Tahvildari M, Rashidi A, Khosravi F, Amirzargar A. Graves' ophthalmopathy and gene polymorphisms in interleukin-1alpha, interleukin-1beta, interleukin-1 receptor and interleukin-1 receptor antagonist. Clin Exp Ophthalmol 2009; 37:614-9. [PMID: 19702713 DOI: 10.1111/j.1442-9071.2009.02093.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Interleukin-1 (IL-1) is known to have an important role in pathogenesis of Graves' ophthalmopathy (GO). Polymorphisms in IL-1 gene have been associated with autoimmune reactions. This study aimed to investigate the association of GO with single-nucleotide polymorphisms (SNPs) in the IL-1 family (IL-1alpha, IL-1beta, IL-1 receptor [IL-1R] and IL-1 receptor antagonist [IL-1RA]). METHODS A total of 57 patients of Graves' disease without GO, 50 patients with GO and 140 healthy controls were enrolled. Patients were recruited consecutively from the outpatient endocrine clinic of a large university general hospital. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. The allele and genotype frequencies of the following polymorphisms were determined: IL-1alpha (-889C/T), IL-1beta (-511C/T), IL-1beta (+3962C/T), IL-1R (Pst-1 1970C/T) and IL-1RA (Mspa-1 11100C/T). Genotype distributions among patients were in Hardy-Weinberg equilibrium for all polymorphisms. RESULTS Among the five SNPs studied, the frequencies of the T allele and the TT genotype of IL-1alpha (-889C/T) were significantly higher among patients with GO than those without GO (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.25-3.74; P = 0.006 and 5.67, 95% CI = 1.66-49.34; P = 0.005, respectively). For IL-1RA (Mspa-1 11100C/T), the frequencies of the C allele and the CC genotype were significantly higher among patients with GO (OR = 2.31, 95% CI = 1.34-4.00; P = 0.004 and 6.73 95% CI = 1.94-23.36; P = 0.004, respectively; P < 0.01). No significant association was found for other SNPs. CONCLUSION This is the first study to show a positive correlation between polymorphisms in the IL-1alpha and IL-1RA genes and susceptibility to GO. These findings promote further research into genetic correlates of GO.
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Affiliation(s)
- Omid Khalilzadeh
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, Tehran, Iran
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17
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Genetic susceptibility to Graves’ ophthalmopathy: the role of polymorphisms in proinflammatory cytokine genes. Eye (Lond) 2009; 24:1058-63. [DOI: 10.1038/eye.2009.244] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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18
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Abstract
The role of cytokines in the pathogenesis of autoimmune thyroid disease (ATD) has been extensively investigated over the past years. In patients with ATD, these molecules can be found in both the thyroid and sites of extrathyroidal complications of the disease. Cytokines can affect the autoimmune process through a number of mechanisms including recruitment of inflammatory cells and upregulation of molecules essential for perpetuation of the inflammatory response in the affected site. In addition, cytokines can interfere with thyroid hormone synthesis, implicating them directly in thyroid dysfunction found in ATD patients. Also, these molecules can modulate the function of cells in orbital tissue, which results in localised oedema, indicating a central role for cytokines in the development of proptosis, the cardinal feature of thyroid associated ophthalmopathy.
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Affiliation(s)
- R A Ajjan
- Academic Unit of Molecular Vascular Medicine, University of Leeds, The General Infirmary at Leeds, Leeds LS1 3EX, UK.
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19
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Increased percentage of L-selectin+ and ICAM-1+ peripheral blood CD4+/CD8+ T cells in active Graves' ophthalmopathy. Folia Histochem Cytobiol 2009; 47:29-33. [DOI: 10.2478/v10042-009-0020-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Wu CH, Chang TC, Liao SL. Results and predictability of fat-removal orbital decompression for disfiguring graves exophthalmos in an Asian patient population. Am J Ophthalmol 2008; 145:755-9. [PMID: 18241831 DOI: 10.1016/j.ajo.2007.11.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 11/23/2007] [Accepted: 11/27/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate proptosis reduction by fat-removal orbital decompression (FROD), to determine the incidence of postoperative diplopia, and to assess predictability of proptosis reduction per volume of resected orbital fat. DESIGN Cross-sectional study. METHODS One hundred and twenty patients (31 men; 89 women) with Graves ophthalmopathy were treated with FROD via the transforniceal approach on 222 orbits between April 2003 and April 2006. Fifteen (12.5%) patients exhibited preoperative diplopia; 105 (87.5%) were without diplopia; mean follow-up +/- standard deviation (SD) was 10.9 +/- 5.1 months (range, six to 37 months). Univariate and multivariate analyses were used to evaluate Hertel change with FROD by linear regression. The setting was thyroid eye disease special clinics at National Taiwan University Hospital. RESULTS Mean Hertel values +/- SD decreased from 20.3 +/- 1.8 mm (range, 16.5 to 26.0 mm) to 16.8 +/- 1.4 mm (range, 13.5 to 21.0). Mean proptosis reduction +/- SD was 3.6 +/- 1.0 mm (range, 1.5 to 7.5 mm). Mean volume of resected orbital fat +/- SD was 3.6 +/- 1.0 ml (range, 1.2 to 6.5 ml). New-onset diplopia was noted for 2.8% of patients after FROD. The final predictive equation for Hertel change is shown as: 0.72 x removal of intraconal fat (ml) - 0.001 x age (yrs) - 0.22 x gender (male, 1; female, 0) - 0.19 x preoperative diplopia (yes, 1; no, 0) + 1.02. CONCLUSIONS FROD can achieve reasonable proptosis reduction and can reduce incidence of new-onset diplopia for patients with disfiguring Graves exophthalmos. The volume of resected orbital fat correlates with mean Hertel value change. The amount of resected orbital fat may predict proptosis reduction.
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Affiliation(s)
- Chien-Hsiu Wu
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan
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21
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Konuk O, Hondur A, Akyurek N, Unal M. Apoptosis in orbital fibroadipose tissue and its association with clinical features in Graves' ophthalmopathy. Ocul Immunol Inflamm 2007; 15:105-11. [PMID: 17558835 DOI: 10.1080/09273940601186735] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the rate of apoptosis in orbital fibroadipose tissue in Graves' ophthalmopathy (GO) patients and investigate its associations with disease characteristics. METHODS Orbital tissue samples were obtained during decompression surgery from 25 GO patients. Disease activity was evaluated using the Clinical Activity Score, while the clinical features of GO were evaluated using the Total Eye Score (TES). Tissue samples of 12 patients without any thyroid or autoimmune disease were studied as controls. The rate of apoptosis was evaluated with a terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling (TUNEL) assay, and ultrastructural features of apoptosis were evaluated with electron microscopy. RESULTS The rate of apoptosis in orbital fibroadipose tissue was significantly higher in GO cases than in the control group (p < 0.001) and significantly correlated with TES (r: 0.545; p = 0.005). The rate of apoptosis was 7.9% +/- 6.5%, and 22.0% +/- 7.8% in type 1 and type 2 cases, respectively (p = 0.001). The rate of apoptosis was 21.6% +/- 7.5% in eyes showing dysthyroid optic neuropathy (DON) and 6.7% +/- 5.4% in eyes without DON (p = 0.005). CONCLUSIONS The rate of apoptosis was high in the orbital fibroadipose tissue of GO cases and was related to the clinical features of the disease.
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Affiliation(s)
- Onur Konuk
- Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey.
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22
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Richter DF, Stoff A, Olivari N. Transpalpebral Decompression of Endocrine Ophthalmopathy by Intraorbital Fat Removal (Olivari Technique): Experience and Progression after More than 3000 Operations over 20 Years. Plast Reconstr Surg 2007; 120:109-123. [PMID: 17572552 DOI: 10.1097/01.prs.0000263655.47148.9e] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Graves' ophthalmopathy is a chronic, multisystem disorder characterized by increased intraorbital fat tissue and hypertrophic extraocular muscles caused by an autoimmune process. Graves' ophthalmopathy represents the most frequent extrathyroidal manifestation of Graves' disease. Clinical findings are impaired ocular motility, diplopia, lid retraction, and impaired visual acuity up to optic neuropathy, with menacing blindness. METHODS Transpalpebral decompression by intraorbital fat removal was first described by Olivari in 1988. From 1984 to 2004, a consecutive series of 1635 patients (3210 eyes) with Graves' ophthalmopathy underwent this operation at the authors' institution. The medical records of 1374 patients (84 percent) could be evaluated retrospectively. RESULTS Postoperatively, the majority of patients showed significant improvements of major symptoms such as ocular protrusion, diplopia, decreased visual acuity, swelling of the eyelids, retrobulbar pressure, and headache. In addition, complications-most of them temporary and reversible-were rare. Because the osseous orbita is not touched, no complications, such as penetration of the dura, infection of the sinus maxillaris, meningitis, irritation of the infraorbital nerve, or obstruction of the lacrimal system, were observed. However, the high number of additional eyelid corrections (average, 2.5 individual corrections) following the decompression indicated the complexity of surgical treatment in endocrine orbitopathy. CONCLUSION Transpalpebral decompression has proved to be reliable, effective, and safe, with good, lasting results leading to an improvement not only in visual function but also in the patient's personal well-being and social life, with a high-benefit-to-low-risk ratio.
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Affiliation(s)
- Dirk F Richter
- Wesseling, Germany From the Department of Plastic and Reconstructive Surgery, Dreifaltigkeits Hospital
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23
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Bujalska IJ, Durrani OM, Abbott J, Onyimba CU, Khosla P, Moosavi AH, Reuser TTQ, Stewart PM, Tomlinson JW, Walker EA, Rauz S. Characterisation of 11beta-hydroxysteroid dehydrogenase 1 in human orbital adipose tissue: a comparison with subcutaneous and omental fat. J Endocrinol 2007; 192:279-88. [PMID: 17283228 PMCID: PMC1994563 DOI: 10.1677/joe-06-0042] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Glucocorticoids (GCs) have a profound effect on adipose biology increasing tissue mass causing central obesity. The pre-receptor regulation of GCs by 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD1) that activates cortisol from cortisone has been postulated as a fundamental mechanism underlying the metabolic syndrome mediating adipocyte hyperplasia and hypertrophy in the omental (OM) depot. Orbital adipose tissue (OF) is the site of intense inflammation and tissue remodelling in several orbital inflammatory disease states. In this study, we describe features of the GC metabolic pathways in normal human OF depot and compare it with subcutaneous (SC) and OM depots. Using an automated histological characterisation technique, OF adipocytes were found to be significantly smaller (parameters: area, maximum diameter and perimeter) than OM and SC adipocytes (P<0 x 001). Although immunohistochemical analyses demonstrated resident CD68+ cells in all three whole tissue adipose depots, OF CD68 mRNA and protein expression exceeded that of OM and SC (mRNA, P<0 x 05; protein, P<0 x 001). In addition, there was higher expression of glucocorticoid receptor (GR)alpha mRNA in the OF whole tissue depot (P<0 x 05). Conversely, 11beta-HSD1 mRNA together with the markers of late adipocyte differentiation (FABP4 and G3PDH) were significantly lower in OF. Primary cultures of OF preadipocytes demonstrated predominant 11beta-HSD1 oxo-reductase activity with minimal dehydrogenase activity. Orbital adipocytes are smaller, less differentiated, and express low levels of 11beta-HSD1 but abundant GRalpha compared with SC and OM. OF harbours a large CD68+ population. These characteristics define an orbital microenvironment that has the potential to respond to sight-threatening orbital inflammatory disease.
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Affiliation(s)
- Iwona J Bujalska
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
| | - Omar M Durrani
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of BirminghamBirminghamUK
| | - Joseph Abbott
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of BirminghamBirminghamUK
| | - Claire U Onyimba
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of BirminghamBirminghamUK
| | - Pamela Khosla
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of BirminghamBirminghamUK
| | | | | | - Paul M Stewart
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
| | - Jeremy W Tomlinson
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
| | - Elizabeth A Walker
- Department of Endocrinology, Division of Medical Sciences, University of BirminghamBirminghamUK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of BirminghamBirminghamUK
- (Requests for offprints should be addressed to S Rauz Academic; )
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24
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Abstract
In thyroid eye disease, autoimmune inflammation of orbital musculature and fat increases the bulk of the orbital contents. Orbital tension rises and patients stratify according to the ease with which their globes can proptose. Restriction of proptosis is associated with optic nerve compression and visual loss; exophthalmos, with corneal damage. Ocular motility is affected, initially by muscle inflammation; late in the disease, by fibrosis. Extraocular factors, including thyroid endocrine disturbance, antigen release, infections, malignancies, and smoking, may trigger and drive the orbital myopathy. The management of thyroid eye disease by the identification and treatment of drives, followed by immunomodulatory therapy, is discussed. Fourteen patients with compressive optic neuropathy were treated with immunomodulation using intravenous methylprednisolone, oral prednisolone, and cyclosporin A, and followed up for a minimum of three years. All recovered their pre-morbid visual acuities and visual fields in both eyes. Severe disturbances of ocular motility also recovered in 30 patients, treated with the same regime. In one subject, ocular motility normalised with intravenous steroids and cyclosporin A, but no oral prednisolone. Morbidity from the treatment was low. Immunomodulation is a rational and successful method for managing optic nerve compression and disordered motility in this condition.
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Affiliation(s)
- P A R Meyer
- Department of Ophthalmology, Addenbrookes Hospital, Cambridge, Cambridgeshire, UK.
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25
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Affiliation(s)
- B Sadowski
- Augenabteilung, Krankenhaus Harlaching, Klara-Heese-Strasse 14, 81545 Münich.
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26
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Han SZ, Zhang SH, Li R, Zhang WY, Li Y. The common −318C/T polymorphism in the promoter region of CTLA4 gene is associated with reduced risk of ophthalmopathy in Chinese Graves' patients. Int J Immunogenet 2006; 33:281-7. [PMID: 16893393 DOI: 10.1111/j.1744-313x.2006.00614.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies in the past have clearly established that CTLA4 is a susceptible gene for Graves' disease (GD). However, association studies between CTLA4 and the risk of developing Graves' ophthalmopathy (GO) in GD patients have shown conflicting results. In this study, associations of five CTLA4 single nucleotide polymorphisms (-1722A/G, -1661A/G, -318C/T, +49G/A, CT60) with GD risk and GO susceptibility in GD patients were investigated in a Chinese population. Our results showed that either +49A/G or CT60 polymorphism was associated with GD susceptibility in the Chinese population. Significant differences in the distribution of the genotypes or alleles evaluated between GD patients with and without clinically evident GO were only found for -318C/T polymorphism (P = 0.03). Multiple logistic regressions revealed that the -318T allele was negatively associated with GO under both additive and dominant genetic models (adjusted OR = 0.56, 95%CI 0.35-0.89, P = 0.014; adjusted OR = 0.51, 95%CI 0.30-0.84, P = 0.009, respectively). Stratification analysis according to gender demonstrated different scenarios concerning the role of the -318T allele in GO risk: a significant protective role for GO was only confirmed in male but not in female GD patients. Haplotype analyses showed that only the haplotypes containing the -318T allele played a protective role in GO. In conclusion, results from this study suggested that the -318T allele might play a protective role in GO susceptibility for GD patients at least in the Chinese population. However, extended analyses with larger sample size should be carried out in patients from different ethnic origins to further verify this association.
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Affiliation(s)
- S Z Han
- State Key Laboratory of Genetic Engineering, Institute of Genetics, School of Life Science, Fudan University, Shanghai, China
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27
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Schäffler A, Müller-Ladner U, Schölmerich J, Büchler C. Role of adipose tissue as an inflammatory organ in human diseases. Endocr Rev 2006; 27:449-67. [PMID: 16684901 DOI: 10.1210/er.2005-0022] [Citation(s) in RCA: 153] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reviews on the inflammatory role of adipose tissue outside the field of metabolism are rare. There is increasing evidence provided by numerous basic research studies from nearly all internal medicine subspecializations that adipocytes and adipocytokines are involved in primary inflammatory processes and diseases. Therefore, it is the aim of the present review to discuss and to summarize the current knowledge on the inflammatory role of adipocytokines and special types of regional adipocytes such as retroorbital, synovial, visceral, subdermal, peritoneal, and bone marrow adipocytes in internal medicine diseases. Future clinical and therapeutic implications are discussed.
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Affiliation(s)
- A Schäffler
- Department of Internal Medicine I, University of Regensburg, Germany.
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28
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Schäffler A, Schölmerich J, Buechler C. The role of 'adipotropins' and the clinical importance of a potential hypothalamic–pituitary–adipose axis. ACTA ACUST UNITED AC 2006; 2:374-83. [PMID: 16932320 DOI: 10.1038/ncpendmet0197] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Accepted: 02/09/2006] [Indexed: 01/17/2023]
Abstract
Since adipocytes express specific receptors for pituitary hormones and hypothalamic releasing factors, adipose tissue has to be regarded as a fast-acting endocrine gland under the control of the brain. Expanding on this suggestion, the existence and clinical impact of a hypothalamic-pituitary-adipose axis is reviewed. The term 'adipotropins' is introduced in order to describe pituitary and hypothalamic hormones or releasing factors that directly target adipocytes by their specific receptors.
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Affiliation(s)
- Andreas Schäffler
- Department of Internal Medicine I, University of Regensburg, Germany.
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29
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Dragan LR, Seiff SR, Lee DC. Longitudinal correlation of thyroid-stimulating immunoglobulin with clinical activity of disease in thyroid-associated orbitopathy. Ophthalmic Plast Reconstr Surg 2006; 22:13-9. [PMID: 16418659 DOI: 10.1097/01.iop.0000192649.23508.f7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the possible correlation between the changes in inflammatory active phase of thyroid-associated orbitopathy (TAO) with measured changes in thyroid-stimulating immunoglobulin (TSI) levels over time. This study was undertaken to evaluate the potential usefulness of measured TSI values in following and treating patients with TAO. METHODS A retrospective chart analysis was performed on 23 patients who had been referred to a tertiary care oculoplastics service between July of 2002 and April of 2004 with suspected TAO. The activity status of patients with TAO was graded by using the TAO activity scale (TAOS), created to distinguish between the active and cicatricial phases of TAO. Laboratory values of TSI reported during the course of the study period were compiled for each study patient. RESULTS Linear regression analysis revealed a statistical correlation between the changes in activity of TAO, as measured by the TAOS score, and changes in measured values of TSI over time. A statistically significant correlation was also found between the activity of TAO (measured by the TAOS score) and TSI value. CONCLUSIONS It was found that changes in inflammatory phase of TAO, as measured by the TAOS score, statistically correlate with changes in measured TSI. An additional correlation was also found between the absolute score of TAO activity and measured level of TSI. These findings suggest that serial TSI measurements may be an adjunct in assessing clinical inflammatory activity of TAO and may help direct clinical decision making regarding treatment decisions in TAO.
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Affiliation(s)
- Laryssa R Dragan
- Department of Ophthalmology, Colorado Permanente Medical Group, Division of Ophthalmic Plastic and Reconstructive Surgery, University of California San Francisco, 94143, USA
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Szucs-Farkas Z, Toth J, Kollar J, Galuska L, Burman KD, Boda J, Leovey A, Varga J, Ujhelyi B, Szabo J, Berta A, Nagy EV. Volume changes in intra- and extraorbital compartments in patients with Graves' ophthalmopathy: effect of smoking. Thyroid 2005; 15:146-51. [PMID: 15753674 DOI: 10.1089/thy.2005.15.146] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to demonstrate the effect of smoking history on soft tissue expansion in specific orbital compartments in patients with Graves' ophthalmopathy. The volumes of the rectus muscles, intra and extraorbital connective, and soft tissues were measured in 110 orbits of 35 patients and 20 control subjects. Data sets from current smokers, ex-smokers, and non-smokers were compared. The total number of cigarettes smoked was calculated, and it was used as an estimate for the severity of smoking (cumulative smoking). The volume measurements were performed on T1-weighted contiguous transversal magnetic resonance images of the orbits. Connective tissue volumes were influenced by smoking history, while muscle volumes were not affected. Ex-smokers had larger amount of extraorbital connective tissue than current smokers (p = 0.012), and this volume showed a good correlation with the number of cigarettes smoked (r = 0.539, p < 0.05). In current smokers, the amount of intraorbital connective tissue correlated well with the cumulative smoking (r = 0.635, p < 0.001). We conclude that connective tissue volumes in certain orbital compartments correlate well with cumulative smoking. Extraocular muscle volumes are not influenced by smoking in patients with Graves' ophthalmopathy.
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Meiss F, Fischer M, Hädecke J, Knorrn M, Marsch WC. [Graves disease. An important differential diagnostic consideration for systemic lupus erythematosus]. Hautarzt 2004; 55:475-9. [PMID: 15024472 DOI: 10.1007/s00105-004-0720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Graves disease is a frequent cause (30-40%) of hyperthyroidism. In addition to the classic clinical triad (goiter, exophthalmos and tachycardia), symptoms relating to other organ systems may be found at presentation. Cutaneous manifestations play an important role and may initially be the only clue to the endocrine disorder. A 40-year-old woman with Graves disease presented with features of systemic lupus erythematosus. She had a malar rash, as well as marked hematological changes (thrombocytopenia and leukocytopenia) and antinuclear antibodies (1:640). She also had hyperthyroidism and Graves disease-specific thyroid autoantibodies (TSIg). Her symptoms improved after initiation of antithyroid therapy. Because of overlapping clinical and laboratory criteria, Graves disease can mimic systemic lupus erythematosus. The differentiation requires careful laboratory evaluation. Moreover, both autoimmune diseases may occur in the same patient.
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Affiliation(s)
- F Meiss
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale).
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Ajjan RA, Weetman AP. New understanding of the role of cytokines in the pathogenesis of Graves' ophthalmopathy. J Endocrinol Invest 2004; 27:237-45. [PMID: 15164999 DOI: 10.1007/bf03345272] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cytokines play a key role in the development of Graves' ophthalmopathy (GO). These molecules are produced in the orbit of GO patients by infiltrating inflammatory cells as well as orbital fibroblasts. Locally produced cytokines stimulate fibroblast proliferation and their production of glycosaminoglycans, which result in accumulation of extracellular matrix and oedema with consequent proptosis. In addition to these direct effects, cytokines can modulate the immune reaction in GO by increasing major histocompatibility complex (MHC) class II, adhesion molecules, CD40, prostaglandin and heat shock protein expression in the orbit, thereby having a role in localising and augmenting the inflammatory response.
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Affiliation(s)
- R A Ajjan
- Academic Unit of Molecular and Vascular Medicine, University of Leeds, The General Infirmary at Leeds, Leeds, United Kingdom
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Tamagno G, De Carlo E, Betterle C, Murialdo G. Graves' ophthalmopathy and atrophic thyroiditis: a case report. J Endocrinol Invest 2004; 27:163-6. [PMID: 15129812 DOI: 10.1007/bf03346262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Graves' ophthalmopathy (GO)--also known as thyroid-associated orbitopathy or ophthalmopathy--usually affects patients with Graves' disease. Antibodies stimulating the TSH receptor are thought to be involved in the pathogenesis of this important and disabling extra-thyroidal manifestation of Graves' disease. Less frequently, GO occurs in subjects who neither have nor have ever shown evidence of thyroid dysfunction ("euthyroid GO"), while the occurrence of GO in patients with autoimmune Hashimoto's thyroiditis is thought to be quite rare and has sporadically been reported. The late and abrupt occurrence of severe GO without hyperthyroidism in an 88-yr-old woman with primary myxedema due to atrophic thyroiditis must be considered as an exceptional event. In this patient, GO was combined with elevated titres of serum auto-antibodies directed against the TSH receptor, while serum levels of anti-thyroglobulin and thyroperoxidase antibodies were within the normal range or only occasionally slightly above the normal values.
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Affiliation(s)
- G Tamagno
- Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
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Abstract
Orbital inflammation is a common problem in adults and children, accounting for the majority of all orbital processes. The presentation may be acute, subacute, or insidious. When the onset is acute, the process can be mistaken for orbital cellulitis. In insidious cases, such as the sclerosing subtype of inflammation, the chronic painless course may prompt concerns about a neoplastic infiltration such as lymphoma. Orbital inflammation can be divided into nonspecific, idiopathic, and other specific diagnoses. The differential diagnosis includes allergic, infectious (fungal, mycobacterial, and parasitic), and neoplastic (lymphoma or metastatic) disease. Orbital inflammation impacts neurologists and neuro-ophthalmologists because all of the entities can cause afferent dysfunction (decreased vision, abnormal color perception, afferent pupillary defect, and visual field defect) and dysmotility. The pattern of motility deficit may mimic the more familiar cranial nerve palsies. Advances in the diagnosis and management of nonspecific orbital inflammation and the specific entities that cause orbital inflammation are discussed.
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Affiliation(s)
- Kimberly P Cockerham
- Neuro-ophthalmology, Orbital Disease and Plastic Reconstruction, Allegheny General Hospital, 420 East North Avenue, Suite 116, Pittsburgh, PA 15212, USA.
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Kaminski HJ, Li Z, Richmonds C, Ruff RL, Kusner L. Susceptibility of Ocular Tissues to Autoimmune Diseases. Ann N Y Acad Sci 2003; 998:362-74. [PMID: 14592898 DOI: 10.1196/annals.1254.043] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The orbital tissues may form a unique immunological environment, as evidenced by autoimmune disorders that specifically target orbital tissues, particularly myasthenia gravis (MG) and Graves' ophthalmopathy (GO). The reasons for the preferential susceptibility are likely to be multiple, based on the interplay of molecular and physiological properties of extraocular muscles (EOM), the unique requirements of the ocular motor system, and the specific autoimmune pathology. Of general importance, even a minor loss of EOM force generation will sufficiently misalign the visual axes to produce dramatic symptoms, and proprioceptive feedback is limited to overcome such a deficit. Particular to MG, EOM synapses appear susceptible to neuromuscular blockade, the autoimmune pathology differs between ocular and generalized MG patients, and the influence of complement regulatory factors may be less prominent in preventing damage at EOM neuromuscular junctions. GO pathogenesis is poorly understood, but shared epitopes of orbital fibroblasts, EOM, and thyroid could lead to specific autoimmune targeting of these tissues. The differential response of orbital fibroblasts to cytokines may be a key factor in disease development. Greater appreciation of the immunologic environment of orbital tissues may lead to therapies specifically designed for orbital autoimmune diseases.
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Affiliation(s)
- Henry J Kaminski
- Department of Neurology, Case Western Reserve University, University Hospitals of Cleveland, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA.
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Farid NR, Marga M. Genetics of thyroid-associated ophthalmopathy: a play in search of a cast of characters. J Endocrinol Invest 2003; 26:570-4. [PMID: 12952374 DOI: 10.1007/bf03345223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- N R Farid
- Osancor Biotech Inc., Watford, Herts, UK.
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Abstract
Any thyroid cancer can metastasize to the uveal tract, even after decades; medullary thyroid cancer can be part of multiple endocrine neoplasia syndrome. Superior limbic keratoconjunctivitis and lagophthalmos are prognostic markers for more severe thyroid-associated ophthalmopathy (TAO). The restrictive ophthalmopathy of TAO may be associated with more sustained ocular hypertension and require topical therapy. Several new studies address the therapy of TAO, ranging from retrobulbar to oral to intravenous glucocorticoids, alone or combined with radiotherapy. Endonasal decompression of the posterior orbit can be done well for severe optic nerve compression; however, leaving the anterior orbital septum intact can minimize postoperative diplopia. Smoking increases the risk and relapse rate for ophthalmopathy. Thyrotropin receptor antigen on fibroblasts diffusely in the body is causative in TAO and pretibial myxedema with even increased urinary secretion of glycosaminoglycans. Corticosteroid-responsive patients show a sustained up-regulation of the Th1/Th2 profile.
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