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Lai PH, Hu RY, Huang X. Alterations in dynamic regional homogeneity within default mode network in patients with thyroid-associated ophthalmopathy. Neuroreport 2024; 35:702-711. [PMID: 38829952 DOI: 10.1097/wnr.0000000000002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Thyroid-associated ophthalmopathy (TAO) is a significant autoimmune eye disease known for causing exophthalmos and substantial optic nerve damage. Prior investigations have solely focused on static functional MRI (fMRI) scans of the brain in TAO patients, neglecting the assessment of temporal variations in local brain activity. This study aimed to characterize alterations in dynamic regional homogeneity (dReHo) in TAO patients and differentiate between TAO patients and healthy controls using support vector machine (SVM) classification. Thirty-two patients with TAO and 32 healthy controls underwent resting-state fMRI scans. We calculated dReHo using sliding-window methods to evaluate changes in regional brain activity and compared these findings between the two groups. Subsequently, we employed SVM, a machine learning algorithm, to investigate the potential use of dReHo maps as diagnostic markers for TAO. Compared to healthy controls, individuals with active TAO demonstrated significantly higher dReHo values in the right angular gyrus, left precuneus, right inferior parietal as well as the left superior parietal gyrus. The SVM model demonstrated an accuracy ranging from 65.62 to 68.75% in distinguishing between TAO patients and healthy controls based on dReHo variability in these identified brain regions, with an area under the curve of 0.70 to 0.76. TAO patients showed increased dReHo in default mode network-related brain regions. The accuracy of classifying TAO patients and healthy controls based on dReHo was notably high. These results offer new insights for investigating the pathogenesis and clinical diagnostic classification of individuals with TAO.
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Affiliation(s)
- Ping-Hong Lai
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Rui-Yang Hu
- School of Ophthalmology and Optometry, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Dallalzadeh LO, Villatoro GA, Chen L, Sim MS, Movaghar M, Robbins SL, Karlin JN, Khitri MR, Velez FG, Korn BS, Demer JL, Rootman DB, Granet DB, Kikkawa DO. Teprotumumab for Thyroid Eye Disease-related Strabismus. Ophthalmic Plast Reconstr Surg 2024; 40:434-439. [PMID: 38985566 DOI: 10.1097/iop.0000000000002611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To assess and quantify teprotumumab's effect on thyroid eye disease-related strabismus by change in measured horizontal and vertical deviations and change in extraocular motility. METHODS We reviewed a series of patients with thyroid eye disease-related strabismus treated with teprotumumab. Exclusion criteria included age under 18 years, strabismus of alternate etiology, or thyroid eye disease-related reconstructive surgery during the treatment course. Primary outcomes were absolute (prism diopters) and relative (%) differences in horizontal and vertical deviations in primary position at distance, as well as change in ductions of the more affected eye. Secondary outcomes included incidence and timing of strabismus surgery postteprotumumab. RESULTS Thirty-one patients were included, with mean age 63 years and thyroid eye disease duration 10 months. After teprotumumab, there was 6 prism diopters (39%) mean reduction in vertical deviation ( p < 0.001), without significant change in mean horizontal deviation ( p = 0.75). Supraduction, abduction, adduction, and infraduction significantly improved in the more restricted eye ( p < 0.01, p < 0.01, p = 0.04, and p = 0.01, respectively). Thirty-five percent of patients underwent strabismus surgery posttreatment, at an average 10 months after last infusion. CONCLUSIONS Teprotumumab produced a statistically significant reduction in vertical but not horizontal strabismus angles in primary position at distance. Extraocular motility in all 4 ductions also improved. A substantial minority of patients still required strabismus surgery following teprotumumab.
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Affiliation(s)
- Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - George A Villatoro
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Lillian Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Myung S Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Mansoor Movaghar
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Shira L Robbins
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Justin N Karlin
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Monica R Khitri
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Federico G Velez
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
| | - Joseph L Demer
- Pediatric Ophthalmology and Strabismus Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, U.S.A
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - Daniel B Rootman
- Orbital and Ophthalmic Plastic Surgery Division, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California, U.S.A
| | - David B Granet
- Division of Pediatric Ophthalmology and Adult Strabismus, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, University of California, San Diego, La Jolla, California, U.S.A
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, La Jolla, California, U.S.A
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Zhang C, Ersan S, Yousef Y, Sandhur B, Desilets J, McGlone C, Kellner T, Teru S, Reynolds AL. The effect of teprotumumab infusion on ocular alignment in patients with symptomatic thyroid eye disease. J AAPOS 2024:103959. [PMID: 38944235 DOI: 10.1016/j.jaapos.2024.103959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Thyroid eye disease (TED) can result in proptosis and ocular misalignment, leading to eye pain, diplopia, and vision loss. Teprotumumab, a humanized antibody against insulin-like growth factor 1 receptor, was approved in 2020 for the treatment of TED. The purpose of this study was to describe the effect of a full course of teprotumumab on ocular misalignment. METHODS The medical records of patients who underwent treatment with teprotumumab for active moderate-to-severe TED at a single institution from April 2020 to September 2023 were reviewed retroactively. Sensorimotor examination was performed at each visit using simultaneous prism-cover testing. Demographic information and previous history of radioactive iodine, steroids, strabismus surgery, and smoking were extracted from the record for analysis. RESULTS A total of 19 patients were treated during the study period, of whom 11 had strabismus and diplopia. The initial absolute horizontal misalignment in these 11 was 6.0Δ ± 1.5Δ, vertical misalignment was 7.7Δ ± 2.4Δ, and total misalignment was 11.5Δ ± 2.0Δ. On completion of treatment, these measurements decreased by 2.0Δ ± 1.5Δ, 2.2Δ ± 1.0Δ, and 3.2Δ ± 1.6Δ, respectively (P = 0.10, 0.02, and 0.04, resp.). Eight patients (73%) had a decrease in their strabismus, and 5 (46%) reported complete resolution of their diplopia at the final visit. No factors were predictive of which patients would have resolution of their misalignment. Of the remaining 3 patients who had no improvement in ocular alignment, 2 (66%) underwent strabismus surgery. Of the 8 patients with improvement of strabismus, only a single patient (13%) underwent strabismus surgery for persistent diplopia. CONCLUSIONS In our study cohort, a full course of teprotumumab coincided with complete resolution of diplopia in 46% of patients and a decrease in strabismus in 73% of patients.
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Affiliation(s)
- Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, Buffalo, New York.
| | - Sinan Ersan
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Yousef Yousef
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Baltaj Sandhur
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Jeffrey Desilets
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Cameron McGlone
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, Buffalo, New York
| | - Thomas Kellner
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, Buffalo, New York
| | - Smaran Teru
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
| | - Andrew L Reynolds
- Department of Ophthalmology, Ross Eye Institute, University at Buffalo, Buffalo, New York
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Beige A, Boustani J, Bouillet B, Truc G. Management of Graves' ophthalmopathy by radiotherapy: A literature review. Cancer Radiother 2024; 28:282-289. [PMID: 38906800 DOI: 10.1016/j.canrad.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 06/23/2024]
Abstract
Orbital radiotherapy for Graves' ophthalmopathy is an example of non-oncological radiotherapy. First introduced in the 1930s, this treatment has become widely used since the 1980s with several studies showing proof of both effectiveness and safety: a decrease of soft tissue involvement in 70 to 80% of patients and an improvement of ocular mobility in 30 to 80% of patients. Nowadays, it's one of the second line treatment options recognized by the European Group on Graves' orbitopathy in the management of a moderate to severe and active disease after failure of glucocorticoids. In that setting, orbital radiotherapy should be combined with glucocorticoids. To our knowledge, there are no practical recommendations on how orbital radiotherapy should be planned and conducted for Graves' ophthalmopathy. Optimal dose is not defined however the most frequent regimen consists of 20Gy in ten fractions of 2Gy, though other options may yield better results. Lastly, the use of modern technique of radiotherapy such as intensity-modulated radiation therapy may allow a better sparing of organs at risk compared to three-dimensional radiotherapy using lateral opposing fields.
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Affiliation(s)
- A Beige
- Radiation therapy department, centre Georges-François-Leclerc, Dijon, France.
| | - J Boustani
- Radiation therapy department, centre hospitalier universitaire de Besançon, Besançon, France
| | - B Bouillet
- Department of endocrinology and diabetology, centre hospitalier universitaire de Dijon, Dijon, France
| | - G Truc
- Radiation therapy department, centre Georges-François-Leclerc, Dijon, France
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Hsu GCY, Shih SR, Chang FY, Liao SL, Wei YH. An Appraisal of the Preventive Effect of Statins on the Development of Graves' Ophthalmopathy: A Hospital-Based Cohort Study. Ophthalmol Ther 2024; 13:1499-1511. [PMID: 38581604 PMCID: PMC11109055 DOI: 10.1007/s40123-024-00930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/07/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Graves' ophthalmopathy (GO) is an autoimmune inflammatory disorder observed in a substantial proportion of patients with Graves' disease (GD), with debilitating symptoms of disfiguring, periorbital pain, dry eyes, diplopia, and even visual disturbances. Previous studies involving Western populations have noted discrepancies in risk factors for GO. Therefore, this study aimed to determine the risk factors for GO development and the protective effect of statins in newly diagnosed patients with GD in Taiwan. METHODS This retrospective case-control study was based on a tertiary center cohort involving patients with GD diagnosed between 2010 and 2019 at the National Taiwan University Hospital (n = 11,035). Patients who were diagnosed or treated elsewhere, had been followed up for less than 6 months or were with a diagnosis of orbital tumor were excluded. Overall, 3578 patients with GD met the inclusion criteria. Univariate and multivariate logistic regression analyses were used to ascertain the odds ratio (OR) of developing GO, with adjustment for sociodemographic factors, interventions for managing GD and thyroid hormone levels, to determine protective and risk factors for GO. RESULTS In our multivariate model, the use of statins reduced the risk of GO development (OR 0.2; 95% confidence interval [CI] 0.08-0.50; p < 0.001). Thyroid dysfunction including hyperthyroidism (OR 4.2; 95% CI 2.97-5.88; p < 0.001) and hypothyroidism (OR 4.7; 95% CI 3.02-7.19; p < 0.001) was associated with an increased risk of developing GO. Smoking status and lipid profile were not risk factors in our cohort. CONCLUSION In newly diagnosed patients with GD, the use of statins decreased the risk of developing GO by 80%, whereas serum lipid levels were not considered risk factors. Further nationwide population-based studies may help clarify the differences in risk factors between various ethnic groups. TRAIL REGISTRATION This trial was approved by the Research Ethics Committee of National Taiwan University Hospital (202202066RINC), retrospectively registered from January 1, 2010 to December 31, 2019.
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Affiliation(s)
| | - Shyang-Rong Shih
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | | | - Shu-Lang Liao
- College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Yi-Hsuan Wei
- College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, Taiwan.
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
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Jeganathan C, Tan JL, Dhepnorrarat C. Rare case of p16-positive oropharyngeal cancer metastasis to the orbit. BMJ Case Rep 2024; 17:e257679. [PMID: 38417943 PMCID: PMC10900310 DOI: 10.1136/bcr-2023-257679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
We describe a case of a man in his 70s who was diagnosed with a p16-positive base of tongue squamous cell carcinoma (SCC) and presented with deteriorating vision and exophthalmos. Imaging revealed medial rectus hypertrophy, and surgery confirmed metastatic p16-positive SCC. Literature reveals that orbital metastasis from any malignancy is a rare occurrence, and even that of p16-positive oropharyngeal SCC has only been reported once in English literature previously. The case highlights the importance of maintaining a wide differential and not being narrowed into a diagnosis or treatment, and given the increasing incidence of human papillomavirus-related cancers, it is important to preserve a high index of suspicion.
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Affiliation(s)
- Chaithanya Jeganathan
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jian Li Tan
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Tan Tock Seng Hospital, Singapore
| | - Chris Dhepnorrarat
- Otolaryngology, Head and Neck Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Liu J, Cai L, Yang R, Wei L, Luo H, Gui X. Risk of allergic rhinitis in patients with inflammatory bowel disease: A systematic review and meta-analysis. Allergol Immunopathol (Madr) 2023; 51:67-75. [PMID: 37937498 DOI: 10.15586/aei.v51i6.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/22/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Numerous parallels exist between inflammatory bowel disease (IBD) and allergic rhinitis (AR), which include risk factors (such as environmental and genetic factors), pathogenesis (immune disorders, epithelial cell barriers, etc.), and treatment (immunosuppressants and immunomodulators, such as cyclosporine and steroids). However, the risk of AR in IBD patients is unknown. OBJECTIVE In this systematic review and meta-analysis, patients with IBD are examined for their risk of AR. METHODS Several databases are accessible in both Chinese and English, including PubMed, BioRXiv, WanFang, the China National Knowledge Infrastructure (CNKI), Web of Science, METSTR, and MedRxiv. Findings presented at allergy, rhinology, thoracic, and gastrointestinal conferences were analyzed. Based on the inclusion and exclusion criteria, two evaluators independently retrieved data, read the literature, and evaluated bias risk. The data analysis was conducted using RevMan 5.4. Case-control and cohort studies were eligible study designs for this research. RESULTS There were 10 case-control studies and 1 cohort study included in the meta-analysis. The experimental group consisted of 65,687 IBD patients, of whom 5838 had AR. A total of 345,176 participants without IBD were included in the control group, of whom 24,625 developed AR. The outcomes demonstrated that IBD patients had a higher risk of developing AR (odds ratio [OR] = 1.48, 95% confidence interval [CI] [1.12, 1.95], Z = 2.78, P = 0.005) than those without IBD. CONCLUSION The risk of AR is higher in IBD patients. Further investigation is required to determine the mechanism behind the association between AR and IBD.
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Affiliation(s)
- Jie Liu
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Lun Cai
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Rongrong Yang
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Liping Wei
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Huazheng Luo
- Department of Internal Medicine, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China
| | - Xiongbin Gui
- Department of Otorhinolaryngology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi University of Chinese Medicine, Nanning, China;
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Ma Y, Lv K, Yang K, Wu H. Secondary ocular hypertension due to tentorial dural arteriovenous fistula: a case report. BMC Ophthalmol 2023; 23:373. [PMID: 37697299 PMCID: PMC10496288 DOI: 10.1186/s12886-023-03124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Tentorial dural arteriovenous fistulas (TDAVFs) are abnormal shunts between meningeal arteries and the intradural venous system located in the tentorial dura mater, which typically manifest with haemorrhage or progressive neurological disorders. TDAVFs with pure ocular presentation have been rarely reported. CASE PRESENTATIONS The case of a 56-year-old man presented with unilateral eye redness, proptosis and elevated intraocular pressure was reported herein, which was caused by a TDAVF. The fistula was fed by the left posterior cerebral artery and posterior meningeal artery. The drainage was into the basal vein and internal cerebral veins, which led the arterial blood flow forward to the left superior ophthalmic vein directly. The redundant blood flow caused the rise of episcleral venous pressure, leading to the clinical presentations. Gamma knife radiosurgery was performed then considering the delicate vascular structure and its deep location. The corkscrew hyperaemia was gradually alleviated after the surgery, but the intraocular pressure remained elevated at follow-ups. CONCLUSION Dural arteriovenous fistulas which are not directly connected to cavernous sinus could cause ocular presentations like proptosis, eye redness and ocular hypertension.
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Affiliation(s)
- Yao Ma
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Kun Lv
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China.
- Eye diseases and optometry Institute, Beijing, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.
- College of Optometry, Peking University Health Science Center, Beijing, China.
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Ramesh S, Zhang QE, Sharpe J, Penne R, Haller J, Lum F, Lee AY, Lee CS, Pershing S, Miller JW, Lorch A, Hyman L. Thyroid Eye Disease and its Vision-Threatening Manifestations in the Academy IRIS Registry: 2014-2018. Am J Ophthalmol 2023; 253:74-85. [PMID: 37201696 PMCID: PMC10525031 DOI: 10.1016/j.ajo.2023.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/31/2023] [Accepted: 04/17/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE To evaluate prevalence of thyroid eye disease (TED) and associated factors in the American Academy of Ophthalmology IRISⓇ Registry (Intelligent Research in Sight). DESIGN Cross-sectional analysis of the IRIS Registry. METHODS IRIS Registry patients (18-90 years old) were classified as TED (ICD-9: 242.00, ICD-10: E05.00 on ≥2 visits) or non-TED cases, and prevalence was estimated. Odds ratios (OR) and 95% Confidence Intervals (CIs) were estimated using logistic regression. RESULTS 41,211 TED patients were identified. TED prevalence was 0.09%, showed a unimodal age distribution (highest prevalence in ages 50-59 years (y) (0.12%)), higher rates in females than males (0.12% vs. 0.04%) and in non-Hispanics than Hispanics (0.10% vs. 0.05%). Prevalence differed by race (from 0.08% in Asians to 0.12% in Black/African-Americans), with varying peak ages of prevalence. Factors associated with TED in multivariate analysis included age: ((18-<30y (reference), 30-39y: OR (95%CI) 2.2 (2.0, 2.4), 40-49y: 2.9 (2.7,3.1), 50-59y: 3.3 (3.1, 3. 5), 60-69y: 2.7 (2.54, 2.85), 70+: 1.5 (1.46, 1.64)); female sex vs male (reference), 3.5 (3.4,3.6), race: White (reference), Blacks: 1.1 (1.1,1.2), Asian: 0.9 (0.8,0.9), Hispanic ethnicity vs not Hispanic (reference), 0.68 (0.6,0.7), smoking status: (never (ref), former: 1.64 (1.6,1.7), current 2.16: (2.1,2.2)) and Type 1 diabetes (yes vs no (reference): 1.87 (1.8, 1.9). CONCLUSIONS This epidemiologic profile of TED includes new observations such as a unimodal age distribution and racial variation in prevalence. Associations with female sex, smoking, and Type 1 diabetes are consistent with prior reports. These findings raise novel questions about TED in different populations.
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Affiliation(s)
- Sathyadeepak Ramesh
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P); The Center for Eye and Facial Plastic Surgery, Somerset, NJ, USA (S.R)
| | - Qiang Ed Zhang
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - James Sharpe
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Robert Penne
- From Department of Oculoplastics and Orbital Surgery, Wills Eye Hospital, Philadelphia, PA, USA (S.R, R.P)
| | - Julia Haller
- Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H)
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA (F.L)
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L); Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA (A.Y.L, C.S.L)
| | - Suzann Pershing
- Byers Eye Institute, Stanford University, and VA Palo Alto Health Care System, Palo Alto, CA, USA (S.P)
| | - Joan W Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA (J.W.M, A.L)
| | - Leslie Hyman
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, PA, USA (Q.Z, J.S, L.H); Wills Eye Hospital, Department of Ophthalmology, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA (Q.Z, J.H, L.H).
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Ye Y, Hu F, Ji Y, Wang R, Zhu K, Kong Q. The outcomes of endoscopic orbital decompression combined with fat decompression for thyroid-associated ophthalmopathy. BMC Ophthalmol 2023; 23:217. [PMID: 37193956 DOI: 10.1186/s12886-023-02957-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE To present the clinical features of thyroid-associated ophthalmopathy (TAO) with different CT types, and to report the outcomes of endoscopic orbital decompression combined with fat decompression (EOD-FD). PATIENTS AND METHODS Thirty-four patients with TAO who underwent EOD-FD between December 2020 and March 2022 in the Ophthalmology Department of Li Huili Hospital Affiliated with Ningbo University, were included in this retrospective interventional case series. Patients were categorized into two groups based on the results of computerized tomography (CT) scans: muscle expansion type and fat hyperplasia type. RESULTS Thirty-four TAO patients (55 eyes) were included in this study, and the mean age was 38.62 years (range 22-60 years). The average eye protrusion (EP) reduced from preoperative 23.20 mm to postoperative 19.66 mm (p < 0.0001). Mean intraocular pressure (IOP) decreased from 20.11 mmHg at baseline to 17.29 mmHg postoperatively (p < 0.0001), with a reduction of 2.84 mmHg (14.12%). Twenty cases of muscle expansion and fourteen cases of fat hyperplasia were definite by CT imaging. The mean IOP in the muscle expansion group was higher than that in the fat hyperplasia group (p < 0.05). Elevated intraocular pressure (IOP) occurred in 23 eyes (36.11%), and it was associated with extraocular muscle involvement, gender, and EP. In 3 cases of impaired vision, the mean best corrected visual acuity (VA) improved from 0.4 preoperatively to 0.84 postoperatively (p < 0.01). There were 8 cases with visual field (VF) damage and/or corneal epithelium damage, and all these damages were reversible. CONCLUSION In this study, we describe the clinical features and experience of EOD-FD in patients with TAO. EOD-FD is an effective technique in reducing IOP and proptosis, with a low incidence of postoperative diplopia.
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Affiliation(s)
- Yunyan Ye
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China
| | - Feng Hu
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China
| | - Yuanfei Ji
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China
| | - Ruijun Wang
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China
| | - Kexuan Zhu
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China
| | - Qiao Kong
- Department of Ophthalmology, Li Huili Hospital affiliated with Ningbo University, Xingning Road-57, Yinzhou District, Ningbo City, Zhejiang Province, China.
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11
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Baeg J, Choi HS, Kim C, Kim H, Jang SY. Update on the surgical management of Graves' orbitopathy. Front Endocrinol (Lausanne) 2023; 13:1080204. [PMID: 36824601 PMCID: PMC9941741 DOI: 10.3389/fendo.2022.1080204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/10/2023] Open
Abstract
Graves' orbitopathy (GO) is a complex autoimmune disorder of the orbit that causes the eye to appear disfigured. GO is typically associated with Graves' disease, an inflammatory autoimmune condition that is caused by thyrotropin receptor autoantibodies. Although our knowledge of the pathophysiology of GO has improved, its exact pathogenesis remains unclear. Some patients suffer from disfigurement, double vision, and even vision loss rather than hyperthyroidism. The disease severity and activity prompt different treatments, as the signs of GO are heterogeneous, so their management can be very complex. Despite medical advances, the first-line treatment for moderate-to-severe active GO is still glucocorticoids, while surgery can be critical for the treatment of chronic inactive GO. Surgery is sometimes required in the acute phase of the disease when there is an immediate risk to vision, such as in dysthyroid optic neuropathy. Most surgeries for GO are rehabilitative and subdivided into three categories: decompression, strabismus repair, and lid surgery. This review is a basic overview of the field, with up-to-date knowledge of the surgical techniques for GO. We review and summarize recent literature on the advances in surgery for GO to provide up-to-date insights on the optimal surgical treatment for GO.
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Affiliation(s)
- Joonyoung Baeg
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Han Sol Choi
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Charm Kim
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
- Department of Ophthalmology, AIN Woman`s Hospital, Incheon, Republic of Korea
| | - Hyuna Kim
- Department of Ophthalmology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Jang
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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12
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Zhang P, Zhu H. Cytokines in Thyroid-Associated Ophthalmopathy. J Immunol Res 2022; 2022:2528046. [PMID: 36419958 PMCID: PMC9678454 DOI: 10.1155/2022/2528046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 09/07/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO), also known as thyroid eye disease (TED) or Graves' orbitopathy (GO), is a complex autoimmune condition causing visual impairment, disfigurement, and harm to patients' physical and mental health. The pathogenesis of TAO has not been fully elucidated, and the mainstream view is that coantigens shared by the thyroid and orbit trigger remodeling of extraocular muscles and orbital connective tissues through an inflammatory response. In recent years, cytokines and the immune responses they mediate have been crucial in disease progression, and currently, common evidence has shown that drugs targeting cytokines, such as tocilizumab, infliximab, and adalimumab, may be novel targets for therapy. In this review, we summarize the research development of different cytokines in TAO pathogenesis in the hope of discovering new therapeutic targets.
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Affiliation(s)
- Pengbo Zhang
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Huang Zhu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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13
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Nair AA, Ediriwickrema LS, Dolman PJ, Law G, Harrison AR, Mokhtarzadeh A, Stewart K, Men C, Lucarelli MJ, van Landingham S, Wingelaar M, Verma R, Chen A, Selva D, Garrity J, Eckel L, Kazim M, Godfrey K, Baxter SL, Korn BS, Kikkawa DO. Predictive Modeling of New-Onset Postoperative Diplopia Following Orbital Decompression for Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2022; 38:551-557. [PMID: 35551414 DOI: 10.1097/iop.0000000000002196] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify risk factors for the development of new-onset, postoperative diplopia following orbital decompression surgery based on patient demographics, clinical exam characteristics, radiographic parameters, and surgical techniques. METHODS We conducted a multi-center retrospective chart review of patients who underwent orbital decompression for thyroid eye disease (TED). Patient demographics, including age, gender, smoking history, preoperative exophthalmometry, clinical activity score (CAS), use of peribulbar and/or systemic steroids, and type of orbital decompression were reviewed. Postoperative diplopia was determined at a minimum of 3 months postoperatively and before any further surgeries. Cross-sectional area ratios of each extraocular muscle to orbit and total fat to orbit were calculated from coronal imaging in a standard fashion. All measurements were carried out using PACS imaging software. Multivariable logistic regression modeling was performed using Stata 14.2 (StataCorp, College Station, TX). RESULTS A total of 331 patients without preoperative diplopia were identified. At 3 months postoperatively, 249 patients had no diplopia whereas 82 patients developed diplopia. The average postoperative follow-up was 22 months (range 3-156) months. Significant preoperative clinical risk factors for postoperative diplopia included older age at surgery, proptosis, use of peribulbar or systemic steroids, elevated clinical activity score, and presence of preoperative compressive optic neuropathy. Imaging findings of enlarged cross-sectional areas of each rectus muscle to the overall orbital area also conferred a significant risk of postoperative diplopia. Regarding surgical factors, postoperative diplopia was more common among those undergoing medial wall decompression, bilateral orbital surgery, and balanced decompression, whereas endoscopic medial wall decompression was found to be relatively protective. CONCLUSIONS This study identifies risk factors associated with the development of diplopia following orbital decompression using multivariable data. This study demonstrates that several characteristics including age, clinical activity score, the cross-sectional muscle to orbit ratios, in addition to the type of orbital decompression surgery, are predictive factors for the development of new-onset postoperative diplopia.
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Affiliation(s)
- Archana A Nair
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Peter J Dolman
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey Law
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew R Harrison
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Ali Mokhtarzadeh
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Krista Stewart
- Department of Ophthalmology and Visual Neurosciences and Otolaryngology, University of Minnesota, Minneapolis, Minnesota
| | - Clara Men
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Mark J Lucarelli
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Suzanne van Landingham
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Maxwell Wingelaar
- Department of Ophthalmology, Oculoplastic, Facial Cosmetic and Orbital Surgery Service, University of Wisconsin-Madison, Madison, Wisconsin
| | - Rohan Verma
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Allison Chen
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Dinesh Selva
- Department of Ophthalmology, Adelaide Skin and Eye Centre, University of Adelaide, Adelaide, Kent Town, South Australia
| | - James Garrity
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Laurence Eckel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Michael Kazim
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York
| | - Kyle Godfrey
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York
| | - Sally L Baxter
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, California
- Division of Plastic and Reconstructive Surgery, UC San Diego Department of Surgery, La Jolla, California
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14
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Kemchoknatee P, Chenkhumwongse A, Dheeradilok T, Srisombut T. Diagnostic Ability of Barrett’s Index and Presence of Intracranial Fat Prolapse in Dysthyroid Optic Neuropathy. Clin Ophthalmol 2022; 16:2569-2578. [PMID: 35983164 PMCID: PMC9381008 DOI: 10.2147/opth.s364987] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Dysthyroid optic neuropathy (DON) is one of the most serious visual loss threats for patients with Graves’ ophthalmopathy (GO). Barrett’s index (BI) and intracranial-fat prolapse have been used in diagnosing DON. However, these parameters are rarely used in Southeast Asian populations with a variety of cut-off values. Objective To evaluate the performance of BI and fat prolapse in diagnosing of DON, and to study the correlation between their parametric values with visual acuity (VA) and visual field defect (VF). Methods Between January 2011 and December 2020, orbits affected by GO were retrospectively reviewed and classified into 2 groups based on the presence or absence of DON. All orbital-computed-tomography (CT) scans were measured for BI and fat prolapse. Diagnostic performance of BI and fat prolapse was analyzed and evaluated in relation to visual outcome. Results We included orbits with DON (23 orbits) and the absence of DON (61 orbits). BI was significantly higher in patients in the DON group (47.68 ± 12.52%) compared to the absence of DON (37.55 ± 10.88%), p < 0.001. The presence of fat prolapse was significantly higher in the DON group (p = 0.003). BI at 40% provided best diagnostic performance with sensitivity of 78.3%/specificity of 63.9%. The presence of fat prolapse 4.5 mm via the superior-ophthalmic-fissure (SOF) had a lower sensitivity compared with fat prolapse 2.5 mm. Comparison between area under the curve (AUC) of BI and fat prolapse revealed no statistically significant difference (AUC 0.742 and 0.705 in BI and fat prolapse, respectively, p = 0.607). A negative correlation between the BI and fat prolapse with VA and VF was observed (p < 0.001). Conclusion Measurement of BI is a simple diagnostic method for detecting DON in Thai populations. The presence of fat prolapse (2.5 mm) provides a lower sensitivity compared with a BI at 40%. A slightly larger BI or fat prolapse should be suspected of DON for early treatment.
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Affiliation(s)
- Parinee Kemchoknatee
- Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
- Correspondence: Parinee Kemchoknatee, Department of Ophthalmology, Rajavithi Hospital, Bangkok, 10400, Thailand, Email
| | - Alisa Chenkhumwongse
- Department of Diagnostic Radiology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | | | - Thansit Srisombut
- Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
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15
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RhoA with Associated TRAb or FT3 in the Diagnosis and Prediction of Graves’ Ophthalmopathy. DISEASE MARKERS 2022; 2022:8323946. [PMID: 35937945 PMCID: PMC9355757 DOI: 10.1155/2022/8323946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/18/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
Abstract
During Graves' disease (GD) treatment, Graves' ophthalmopathy (GO) is often ignored because only mild ocular symptoms are present in early GD. Therefore, we performed isobaric tags for relative and absolute quantification (iTRAQ) analysis and measured relevant endocrine hormones to identify predisposing factors of GO. Serum samples from 3 patients with mild GD and GO and 3 patients with GD but without GO were analyzed by iTRAQ. Based on their clinical data, 60 patients with GD were divided into the GO-free and GO groups. All patients were followed up for 7 months. Their eye conditions and changes in related biochemical indexes were recorded. The iTRAQ results showed that RhoA expression was upregulated and correlated significantly with the tight junction pathway and immunity. The changes in FT3 and RhoA from baseline to 7 months, the FT3 and RhoA baseline levels, and the TRAb titer levels in patients with GD significantly differed between the groups. ELISA and western blotting for RhoA, TRAb, and FT3 in the serum samples from GO patients showed significant upregulation, as well as elevated serum RhoA and TRAb levels in the mild stage of GO. At 7 months, the serum RhoA and FT3 levels were elevated. RhoA is a potential biomarker for mild GO. In GD patients, if an elevated serum RhoA level is accompanied by an elevated TRAb or FT3 level, GO is highly likely to occur, even when obvious ocular symptoms are absent.
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16
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Poon SHL, Cheung JJC, Shih KC, Chan YK. A systematic review of multimodal clinical biomarkers in the management of thyroid eye disease. Rev Endocr Metab Disord 2022; 23:541-567. [PMID: 35066781 DOI: 10.1007/s11154-021-09702-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/25/2022]
Abstract
Thyroid Eye Disease (TED) is an autoimmune disease that affects the extraocular muscles and periorbital fat. It most commonly occurs with Graves' Disease (GD) as an extrathyroidal manifestation, hence, it is also sometimes used interchangeably with Graves' Ophthalmopathy (GO). Well-known autoimmune markers for GD include thyroid stimulating hormone (TSH) receptor antibodies (TSH-R-Ab) which contribute to hyperthyroidism and ocular signs. Currently, apart from radiological investigations, detection of TED is based on clinical signs and symptoms which is largely subjective, with no established biomarkers which could differentiate TED from merely GD. We evaluated a total of 28 studies on potential biomarkers for diagnosis of TED. Articles included were published in English, which investigated clinical markers in tear fluid, orbital adipose-connective tissues, orbital fibroblasts and extraocular muscles, serum, thyroid tissue, as well as imaging biomarkers. Results demonstrated that biomarkers with reported diagnostic power have high sensitivity and specificity for TED, including those using a combination of biomarkers to differentiate between TED and GD, as well as the use of magnetic resonance imaging (MRI). Other biomarkers which were upregulated include cytokines, proinflammatory markers, and acute phase reactants in subjects with TED, which are however, deemed less specific to TED. Further clinical investigations for these biomarkers, scrutinising their specificity and sensitivity on a larger sample of patients, may point towards selection of suitable biomarkers for aiding detection and prognosis of TED in the future.
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Affiliation(s)
- Stephanie Hiu Ling Poon
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
| | | | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR.
| | - Yau Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 301B Cyberport 4, 100 Cyberport Road, Pokfulam, Hong Kong SAR
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17
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Pelewicz M, Rymuza J, Pelewicz K, Miśkiewicz P. Dysthyroid Optic Neuropathy: Treatment with Additional Intravenous Methylprednisolone Pulses after the Basic Schedule Is Associated with Stabilization or Further Improvement of Clinical Outcome. J Clin Med 2022; 11:jcm11082068. [PMID: 35456161 PMCID: PMC9026539 DOI: 10.3390/jcm11082068] [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: 02/20/2022] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Dysthyroid optic neuropathy (DON) is a sight-threatening complication of Graves’ orbitopathy (GO). Treatment of DON consists of the urgent administration of intravenous methylprednisolone (ivMP) in very high doses followed by orbital decompression if the response is poor or absent. It is advised to continue the therapy with pulses of ivMP in a weekly schedule. The purpose of this study was to evaluate the impact of the additional treatment with ivMP in a 12-week protocol on visual acuity (VA), color vision, clinical activity score (CAS) and proptosis in patients with DON. Methods: This study was performed on 19 patients with DON (26 eyes) treated with ivMP in very high doses, with further orbital decompression in 11 individuals (15 eyes). VA, color vision, CAS and proptosis were evaluated prior to the DON treatment, before and after the 12-week ivMP (first and last pulse). Additionally follow up was performed (22 eyes). Results: VA and color vision improved between the first and last pulse of the additional ivMP treatment (p = 0.04 and p = 0.003, respectively). CAS and proptosis were reduced at the end of the 12-week ivMP therapy compared to observations at the beginning (p < 0.001 and p = 0.04, respectively). Follow up confirmed stabilization of this achievement. Conclusions: The results of this study suggest that additional treatment with 12 pulses of ivMP improves or stabilizes the outcome of basic therapy in patients with DON.
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18
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Tagami M, Honda S, Azumi A. Insights into Current Management Strategies for Dysthyroid Optic Neuropathy: A Review. Clin Ophthalmol 2022; 16:841-850. [PMID: 35330749 PMCID: PMC8939905 DOI: 10.2147/opth.s284609] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 01/20/2023] Open
Abstract
Dysthyroid optic neuropathy (DON) is a potentially sight-threatening eye disease associated with Graves’ orbitopathy (GO). DON is not common in GO patients, reportedly occurring in only about 5% of patients. The pathogenesis of severe DON is considered to involve both muscular nerve strangulation and impaired blood flow. There is some objective grading of physical examination findings and the severity of GO, including a clinical activity score (CAS) and EUropean Group On Graves’ Orbitopathy (EUGOGO), but no specialized protocol completely characterizes DON. Most clinicians have decided that the combination of clinical activity findings, including visual acuity, color vision, and central critical fusion frequency, and radiological findings, including magnetic resonance imaging (MRI), can be used to diagnose DON. MRI has the most useful findings, with T2-weighted and fat-suppressed images using short-tau inversion recovery (STIR) sequences enabling detection of extraocular changes including muscle and/orbital fat tissue swelling and inflammation and, therefore, disease activity. The first-choice treatment for DON is intravenous administration of steroids, with or without radiotherapy. Unfortunately, refractoriness to this medical treatment may indicate the need for immediate orbital decompression within 2 weeks. Especially in the acute phase of DON, thyroid function is often unstable, and the surgeon must always assume the risk of general anesthesia and intra- and post-operative management. In addition, there are currently many possible therapeutic options, including molecular-targeted drugs. The early introduction and combination of these immunomodulators, including Janus kinase inhibitors and insulin-like growth factor-1 receptor antibody (teprotumumab), may be effective for GO with DON. However, this is still under investigation, and the number of case reports is small. It is possible that these options could reduce systemic adverse events due to unfocused glucocorticoid administration. The pathophysiology of DON is not yet fully understood, and further studies of its treatment and long-term visual function prognosis are needed.
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Affiliation(s)
- Mizuki Tagami
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Correspondence: Mizuki Tagami, Department of Ophthalmology and Visual Science, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka-shi, 545-8586, Japan, Tel/Fax +81-6-6645-3867, Email
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Atsushi Azumi
- Ophthalmology Department and Eye Center, Kobe Kaisei Hospital, Kobe, Hyogo, Japan
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19
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Cohen LM, Liou VD, Cunnane ME, Yoon MK. Radiographic analysis of fatty infiltration of the extraocular muscles in thyroid eye disease. Orbit 2022; 41:53-58. [PMID: 32878536 DOI: 10.1080/01676830.2020.1817100] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Fatty infiltration of the extraocular muscles has been described radiographically in patients with thyroid eye disease (TED), yet it has not been studied on a large scale nor quantified. Our purpose was to define and characterize this entity in patients with TED. METHODS An IRB-approved cross-sectional retrospective review of medical records identified patients with a clinical diagnosis of TED and at least one CT of the orbits. A 2:1 age and sex-matched control population consisted of patients without a history nor radiographic evidence of orbital disease or systemic thyroid abnormality. The presence of fatty infiltration in each extraocular rectus muscle was defined using Hounsfield units (HU). Laterality, muscles involved, and pattern of fatty infiltration were also evaluated. Student's t-tests, Chi-square, and Fisher's exact tests were used to compare TED and control groups. RESULTS The study population consisted of 252 patients with TED and 504 age and sex-matched controls. Fatty infiltration was significantly more prevalent in TED patients (36/252, 14.3%) compared to controls (11/504, 2.2%) (p < .001). The mean density of fat infiltration was significantly lower in TED patients (-40.4 HU) than controls (-34.8 HU) (p = .048). In TED patients, the frequency of muscle involvement was inferior rectus (61.8%), lateral rectus (19.7%), superior rectus (11.8%) and medial rectus (6.6%), which was not significantly different than controls (p > .05). Most muscles (88.2%) in the TED group exhibited a heterogeneous pattern of infiltration, which did not differ from controls (p = .34). CONCLUSIONS This study characterizes fatty infiltration of the extraocular muscles in patients with TED.
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Affiliation(s)
- Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye Institutes, University of California, Los Angeles, CA, USA
| | - Victor D Liou
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Mary Elizabeth Cunnane
- Neuroradiology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Michael K Yoon
- Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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20
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Yang S, Wang X, Xiao W, Xu Z, Ye H, Sha X, Yang H. Dihydroartemisinin Exerts Antifibrotic and Anti-Inflammatory Effects in Graves' Ophthalmopathy by Targeting Orbital Fibroblasts. Front Endocrinol (Lausanne) 2022; 13:891922. [PMID: 35663306 PMCID: PMC9157422 DOI: 10.3389/fendo.2022.891922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Graves' ophthalmopathy (GO) is a common orbital disease that threatens visual function and appearance. Orbital fibroblasts (OFs) are considered key target and effector cells in GO. In addition, hyaluronan (HA) production, inflammation, and orbital fibrosis are intimately linked to the pathogenesis of GO. In this study, we explored the therapeutic effects of dihydroartemisinin (DHA), an antimalarial drug, on GO-derived, primary OFs. CCK8 and EdU assays were applied to evaluate the antiproliferative effect of DHA on OFs. Wound healing assays were conducted to assess OF migration capacity, while qRT-PCR, western blotting, ELISA, and immunofluorescence were used to determine the expression of fibrosis-related and pro-inflammatory markers in these cells. Moreover, RNA sequencing was conducted to identify differentially expressed genes (DEGs) in DHA-treated OFs, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of DEGs was performed to explore potential mechanisms mediating the antifibrotic effect of DHA on GO-derived OFs. Results showed that DHA dose-dependently inhibited OF proliferation and downregulated, at the mRNA and protein levels, TGF-β1-induced expression of fibrosis markers, including alpha smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF). Furthermore, DHA inhibited TGF-β1 induced phosphorylation of extracellular signal-regulated protein kinase 1/2 (ERK1/2) and signal transducer and activator of transcription 3 (STAT3), which suggested that DHA exerted antifibrotic effects via suppression of the ERK and STAT3 signaling pathways. In addition, DHA suppressed the expression of pro-inflammatory cytokines and chemokines, including IL-6, IL-8, CXCL-1, MCP-1, and ICAM-1, and attenuated HA production induced by IL-1β in GO-derived OFs. In conclusion, our study provides first-time evidence that DHA may significantly alleviate pathogenic manifestations of GO by inhibiting proliferation, fibrosis- and inflammation-related gene expression, and HA production in OFs. These data suggest that DHA may be a promising candidate drug for treatment of GO.
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Kwak J, Lee DC. Correlation between Thyroid-stimulating Antibody Level Change and Extraocular Muscle Thickness Change in Thyroid Eye Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.10.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To investigate the changes in extraocular muscle thicknesses by variations in the thyroid stimulating antibody (TSAb) level in patients with thyroid eye disease (TED).Methods: A total of 67 TED patients were enrolled. They were divided into two groups: an experimental group with clinically significant elevated TSAb levels (≥140 IU/L) and a control group (TSAb <140 IU/L). All of the lateral, medial, superior, and inferior rectus muscle thicknesses were measured with the aid of anterior segment optical coherence tomography (OCT). The average thicknesses for both eyes were recorded for each patient based on the values measured at the ends of the muscles (which become vertically thinner from the points of tendon attachment). We measured changes in TSAb levels and extraocular muscle thicknesses after two follow-up periods and sought correlations among these parameters.Results: At the initial visits, the inferior rectus muscle thickness was positively correlated with the TSAb level in the experimental group (p = 0.045, r = 0.478). None of the medial, superior, or lateral rectus muscle thicknesses were so correlated. On follow-up, the variation in TSAb level correlated negatively with changes in lateral rectus muscle thickness (p = 0.038, r = -0.357). The superior rectus muscle thickness tended to be negatively correlated with the TSAb level, but statistical significance was not attained (p = 0.146, r = -0.669). The thicknesses of the inferior and superior rectus muscles did not change over time.Conclusions: In TED patients, TSAb variations seem to reflect the extent of periorbital tissue edema, thus correlating negatively with especially lateral rectus muscle thickness changes.
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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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Choi JH, Noh H, Kim YD, Woo KI. Prognostic factors of restrictive myopathy in thyroid eye disease. Sci Rep 2021; 11:13781. [PMID: 34215786 PMCID: PMC8253730 DOI: 10.1038/s41598-021-93275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/23/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the prognostic factors of extraocular muscle restriction in patients with thyroid eye disease (TED), 65 patients with TED and restrictive myopathy were evaluated. Demographics, clinical activity score (CAS), smoking status, thyroid disease status, thyroid hormone status, thyroid autoantibody status, orbital computed tomography (CT) scan at initial presentation, and treatment regimens were assessed. The movements of the most severely affected extraocular muscles were categorized into five grades. The patients were divided into the improved and the not-improved group based on the improvement in the limitation of the extraocular muscle excursion (LOM) throughout the follow-up, and the groups were compared using clinical factors. The mean LOM significantly improved from 2.3 ± 1.1 to 1.7 ± 1.2 after 1 year of follow-up. The excursion of the most restricted muscle improved in 32 patients but not in 33 patients during the follow-up. The initial concentration of the thyroid-stimulating antibody (TSAb) was significantly lower in the improved (229.3 ± 114.1) than in the not-improved group (345.0 ± 178.6) (P = 0.02) Age, sex, smoking status, CAS, thyroid status, and muscle thickness on the CT scan did not significantly differ in the groups. This study showed that the initial concentration of TSAb is a factor affecting the recovery of restrictive myopathy.
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Affiliation(s)
- Jae Hwan Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Hoon Noh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | | | - Kyung In Woo
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Jung SJ, Choi YJ, Park TK, Woo SE, Kim BY, Yoon JS, Jang SY. Wnt signalling inhibits adipogenesis in orbital fibroblasts from patients with Graves' orbitopathy. Br J Ophthalmol 2021; 106:1019-1027. [PMID: 34193409 DOI: 10.1136/bjophthalmol-2020-316898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIMS To investigate the role of Wnt signalling in adipogenesis using an in vitro model of Graves' orbitopathy (GO). METHODS Orbital fat was obtained from patients with GO and non-GO participants for primary orbital fibroblast (OF) culture. Expression levels of Wnt5a, Wnt10b, β-catenin, phospho-β-catenin and cyclin D1 were compared between GO and non-GO OFs. These expression levels were also determined during adipogenesis of GO and non-GO OFs. The effects of a stimulator and inhibitor of Wnt signalling on adipogenesis of GO and non-GO OFs were investigated. RESULTS Western blotting analysis showed significant reductions in β-catenin and cyclin D1 and significant enhancement of phospho-β-catenin in OFs from patients with GO, compared with OFs from non-GO participants (p<0.05). Expression of Wnt5a, Wnt10b, β-catenin and cyclin D1 in OFs was highest on day 0, and then gradually declined after induction of adipogenic differentiation. The expression levels of PPARγ, C/EBPα and C/EBPβ were reduced in Wnt stimulator-treated OFs in a dose-dependent manner. Oil red O staining confirmed that a stimulator of Wnt inhibited adipogenesis in GO OFs. CONCLUSION These results indicate that Wnt signalling inhibits adipogenesis in OFs from patients with GO and non-GO participants. Further studies are required to examine the potential of Wnt signalling as a target for therapeutic strategies.
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Affiliation(s)
- Sang Joon Jung
- Department of Ophthalmology, Korea Army Training Center, Republic of Korea Army, Nonsan-si, Republic of Korea
| | - Yeon Jeong Choi
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Tae Kwann Park
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Sang Earn Woo
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Bo-Yeon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Severance Hospital, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sun Young Jang
- Department of Ophthalmology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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Garip Kuebler A, Halfter K, Reznicek L, Klingenstein A, Priglinger S, Rudolph G, Hintschich C. A pathological indicator for dysthyroid optic neuropathy: tritan color vision deficiency. Graefes Arch Clin Exp Ophthalmol 2021; 259:3421-3426. [PMID: 34159407 PMCID: PMC8523501 DOI: 10.1007/s00417-021-05227-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To investigate the sensitivity of the color vision test by Arden in patients with dysthyroid optic neuropathy (DON) to improve diagnosis. Methods In this observational, retrospective study, we included the medical records of 92 eyes (48 patients) with diagnosis of DON between 2008 and 2019 in order to evaluate the full spectrum of findings from the color vision test by Arden, and to determine potential importance of this test. Thirty-five patients were female, and 13 patients were male. The mean age was 58.0 years (range: 34–79) at the time of the DON diagnosis. Results Forty-one eyes displayed relatively good BCVA with ≤ 0.2 LogMAR. We found a protan value exceeding the threshold of ≥ 8% in 57 eyes (30 patients) at the time of the diagnosis. The sensitivity of protan was 61.9% (95% CI 51.2–71.8%), while that of tritan was a striking 98.9% (95% CI 94.1–99.9%). We discovered one pathological sign, tritan deficiency (based on a threshold of ≥ 8%) consistently in all eyes but one at the time of the diagnosis, regardless of the visual field defects or any changes in best-corrected visual acuity (BCVA). Conclusion We found blue-yellow (tritan) deficiency, to be a sensitive and reliable indicator of dysthyroid optic neuropathy. We conclude that, in cases with suspected DON, a color vision test that can detect tritan deficiency is an essential tool for the adequate assessment, diagnosis, and treatment of DON.
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Affiliation(s)
- Aylin Garip Kuebler
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany.
| | - Kathrin Halfter
- The Institute for Medical Information Processing, Ludwig-Maximilians-University, Biometry and Epidemiology Marchioninistr. 15, 81377, Munich, Germany
| | - Lukas Reznicek
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany
| | - Annemarie Klingenstein
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany
| | - Günther Rudolph
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany
| | - Christoph Hintschich
- Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstr. 8 80336, Munich, Germany
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Abstract
Purpose: To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab.Methods: A retrospective series of patients with chronic thyroid eye disease (TED) and low clinical activity score (CAS) treated with teprotumumab infusion therapy. Inclusion criteria: adults over 18 years of age with TED for greater than 9 months and CAS of 1 or less. All patients included in the analyses completed a full series of eight infusions. Primary outcome measures included proptosis and eyelid retraction in both eyes. Secondary outcomes included CAS, reported adverse effects, and surgery post-treatment.Results: Nine patients met all inclusion criteria, seven females and two males with mean age of 50.2 years and TED diagnosis of 6.25 years. Three patients had a baseline CAS of 1 and 6 had a CAS of 0. Mean proptosis reduction in the worse eye was 4.0 ± 2.4 mm immediately post-treatment (p = .02). Five out of nine patients had extended follow-up (average 16.8 ± 5.1 weeks) with mean proptosis reduction of 4.2 ± 2.8 mm at last follow-up (p = .03). Mean reduction in eyelid retraction in the worse eye was 0.3 ± 1.6 mm post-treatment (p = .58) and 0.5 ± 0.9 mm at last follow-up (p = .30). Three patients reported infusion-related myalgias, two hair thinning, one exacerbated chronic tinnitus, and one hyperglycemia.Conclusions: We report clinically and statistically significant proptosis reduction in nine patients with chronic, low CAS TED treated with teprotumumab. Teprotumumab may be an effective treatment option for these patients.
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Affiliation(s)
- Daniel J Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
| | - Liane O Dallalzadeh
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, USA
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Lee J, Lee DC. Correlation between Changes in Thyroid Stimulating Immunoglobulin Levels and Chorioretinal Vessels in Thyroid Eye Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.5.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Denisova K, Barmettler A. Evaluating the Thyroid Eye Disease Patient. Int Ophthalmol Clin 2021; 61:33-52. [PMID: 33743527 DOI: 10.1097/iio.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Dave TV, Patodi P, Richhariya A, Dave VP. Thermal Imaging of the Ocular Surface in Thyroid Eye Disease: A Comparison between Active, Inactive and Healthy Eyes. Curr Eye Res 2021; 46:1482-1488. [PMID: 33745401 DOI: 10.1080/02713683.2021.1907418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim: To report the temperature differences on the ocular surface using infrared thermal imaging (TI) in thyroid eye disease (TED) and healthy eyesMethods: Prospective, consecutive, comparative case series comparing TI parameters between active and inactive TED with healthy controls. The data captured included baseline demography, activity of TED and the TI parameters. Area under the receiver operating characteristic curves (AUROC) were calculated for the temperature values to determine the sensitivity and specificity in distinguishing active from inactive TED. The Youden index and the predictor cut off values were also reported.Results: The study included 11 eyes with active TED, 46 eyes with inactive TED and 40 eyes healthy patients. Temperatures of pre-determined points on the ocular surface in degrees were compared between the three groups. Temperature at the caruncle, medial and lateral conjunctiva was noted to be significantly higher in the active TED group compared to inactive TED and healthy eyes. The most favorable Youden index (0.7) was noted for the caruncle with an AUROC value of 0.91, a sensitivity of 91% and a specificity of 79%. Correlation coefficient for the caruncular temperature with the corresponding CAS (clinical activity score) was 0.65 (95% C.I. 0.45 to 0.78, p < .0001).Conclusion: Thermal imaging in TED is an objective way of documenting surface inflammation by the surrogate marker of temperature change. It supplements CAS in clinically evident cases and could be useful in staging eyes with subtle clinical signs as well as those where signs have reduced following initiation of treatment.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Palash Patodi
- Ophthalmic Engineering Department, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Ashutosh Richhariya
- Ophthalmic Engineering Department, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Kurt MM, Akpolat C, Evliyaoglu F, Yilmaz M, Ordulu F. Evaluation of Retinal Neurodegeneration and Choroidal Thickness in Patients with Inactive Graves' Ophthalmopathy. Klin Monbl Augenheilkd 2021; 238:797-802. [PMID: 33733445 DOI: 10.1055/a-1275-0703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE The study was conducted for the assessment of the retinal nerve fiber layer, ganglion cell layer, and subfoveal choroidal thickness changes in patients with inactive Graves' ophthalmopathy (GO) using swept-source optical coherence tomography (SS-OCT) before the development of active GO findings. MATERIALS AND METHODS The cross-sectional designed study consisted of patients with inactive Graves' ophthalmopathy (study group) and healthy subjects (control group). The thicknesses of the retinal ganglion cell layer, retinal nerve fiber layer, and subfoveal choroid (SFCT) were measured using SS-OCT with deep range imaging technology to compare these parameters between the study and control groups. RESULT Patients with inactive Graves' ophthalmopathy had higher values of intraocular pressure but similar best-corrected visual acuity (p = 0.001, p = 0.232, respectively). The retinal nerve fiber layer was thinner only in the superior zone of the study group (p = 0.039), whereas similar values were noted in the temporal, nasal, and inferior areas as well as the average thickness. We did not observe any statistically significant difference in any sector of the ganglion cell layer between the study and control groups. A thicker mean subfoveal choroidal thickness value was measured in patients with inactive Graves' ophthalmopathy than in healthy subjects (p = 0.013) in correlation with a clinical activity score (p = 0.046). CONCLUSION SS-OCT showed minimal retinal neurodegenerative alteration and significant choroidal thickening in inactive GO. Thus, SS-OCT might be a beneficial technique to detect retinal neurodegenerative and choroidal changes earlier in the stage of inactive GO before the development of active GO signs, which may affect the time and type of treatment modalities to prevent further ocular or systemic complications. Additionally, SFCT may be a good indicator for assessment of the severity of Graves' disease.
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Affiliation(s)
- Muhammed M Kurt
- Ophthalmology, Samsun Gazi Community Hospital, Samsun, Turkey
| | - Cetin Akpolat
- Ophthalmology, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Ferhat Evliyaoglu
- Ophthalmology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Merve Yilmaz
- Endocrinology, Samsun Gazi Community Hospital, Samsun, Turkey
| | - Fikriye Ordulu
- Ophthalmology, Samsun Gazi Community Hospital, Samsun, Turkey
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Unsworth SP, Heisel CJ, Tingle CF, Rajesh N, Kish PE, Kahana A. Retinoic Acid Potentiates Orbital Tissues for Inflammation Through NF-κB and MCP-1. Invest Ophthalmol Vis Sci 2021; 61:17. [PMID: 32663289 PMCID: PMC7425727 DOI: 10.1167/iovs.61.8.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose The orbit displays unique vulnerability to inflammatory conditions. The most prevalent of these conditions, thyroid eye disease (TED), occurs in up to 50% of patients with Graves’ disease (GD). Whereas the pathology of both TED and GD is driven by autoantibodies, it is unclear why symptoms manifest specifically in the orbit. Methods We performed retinoic acid treatment on both normal and TED patient–derived orbital fibroblasts (OFs) followed by mRNA and protein isolation, quantitative real-time polymerase chain reaction (qRT-PCR), enzyme-linked immunosorbent assay, RNA sequencing, and Western blot analyses. Results Both normal and TED patient–derived OFs display robust induction of monocyte chemoattractant protein 1 (MCP-1) upon retinoid treatment; TED OFs secrete significantly more MCP-1 than normal OFs. In addition, pretreatment of OFs with thiophenecarboxamide (TPCA-1) inhibits retinoid-induced MCP-1 induction, suggesting an NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells)–dependent mechanism. We also found that treatment with cholecalciferol (vitamin D3) mitigates MCP-1 induction, likely because of competition between retinoic acid receptors (RARs) and vitamin D receptors (VDR) for their common binding partner retinoid nuclear receptors (RXRs). Conclusions Retinoids that naturally accumulate in orbital adipose tissue can act on orbital fibroblasts to induce the expression of inflammation-associated genes. These data suggest a potential role for retinoids in sensitizing the orbit to inflammation.
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Jiang L, Rong A, Wei R, Diao J, Ding H, Wang W. Tear proteomics of orbital decompression for disfiguring exophthalmos in inactive thyroid-associated ophthalmopathy. Exp Ther Med 2020; 20:253. [PMID: 33178351 PMCID: PMC7654220 DOI: 10.3892/etm.2020.9383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/20/2020] [Indexed: 12/25/2022] Open
Abstract
The progress and achievements that have been made in tear proteomics in thyroid-associated ophthalmopathy (TAO) are critical for exploring the pathogenesis of TAO and investigating potential therapeutic targets. However, the tear proteomics of orbital decompression for disfiguring exophthalmos in inactive TAO have yet to be properly investigated. In the present study, orbital decompression was performed to repair disfiguring exophthalmos in patients with inactive TAO. Tears were collected before and after orbital decompression in patients with inactive TAO. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) was performed to explore the changes in tear proteomics. Bioinformatics analyses were then employed to analyze the functions of the differentially expressed proteins (DEPs) identified by LC-MS/MS. The palpebral fissure height and exophthalmia area were significantly restored after 1 month of orbital decompression such that they approached the normal levels identified in healthy eyeballs. Among the 669 proteins identified by LC-MS/MS, 83 proteins were changed significantly between the preoperative and postoperative stages in inactive TAO patients and healthy control individuals. The DEPs were predicted to be involved in numerous signaling pathways. Bioinformatics analyses revealed that pathways associated with the immune system, metabolism, programmed cell death, vesicle-mediated transport, neuronal system and extracellular matrix organization may fulfill significant roles in orbital decompression in patients with inactive TAO. Taken together, these results provided a preliminary understanding of the mechanism of orbital decompression for disfiguring exophthalmos in inactive TAO patients.
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Affiliation(s)
- Lihong Jiang
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, P.R. China.,Department of Ophthalmology, Zhabei Central Hospital, Jingan District, Shanghai 200070, P.R. China
| | - Ao Rong
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, P.R. China
| | - Ruili Wei
- Department of Ophthalmology, Changzheng Hospital, Naval Medicine University, Shanghai 200003, P.R. China
| | - Jiale Diao
- Department of Ophthalmology, Changzheng Hospital, Naval Medicine University, Shanghai 200003, P.R. China
| | - Hui Ding
- Department of Ophthalmology, Zhabei Central Hospital, Jingan District, Shanghai 200070, P.R. China
| | - Wei Wang
- Department of Ophthalmology, Zhabei Central Hospital, Jingan District, Shanghai 200070, P.R. China
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Cheng AMS, Wei YH, Liao SL. Strategies in Surgical Decompression for Thyroid Eye Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:3537675. [PMID: 32963693 PMCID: PMC7501557 DOI: 10.1155/2020/3537675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
Surgical management of thyroid eye disease- (TED-) associated morbidity has been plagued by the complex interplay of different operative techniques. Orbital decompression is the well-recognized procedure for disfiguring exophthalmos and dysthyroid optic neuropathy (DON). There are numerous published techniques described for the removal of the orbital bone, fat, or a combination. The diverse studies are noncomparative as they include different indications, stages of disease, and methods of evaluation. Thus, it is difficult to conclude the most efficient decompression technique. To obtain effective and predictable results, it is therefore important to propose a logical and acceptable clinical guideline to customize patient treatment. Herein, we developed an algorithm based on the presence of DON, preoperative existing diplopia, and severity of proptosis which were defined by patient's disabling symptoms together with a set of ocular signs reflecting visual function or cosmesis. More specifically, we aimed to assess the minimal but effective surgical technique with acceptable potential complications to achieve therapeutic efficacy. Transcaruncular or inferomedial decompressions are indicated in restoring optic nerve function in patients with DON associated with mild or moderate to severe proptosis, respectively. Inferomedial or fatty decompressions are effective to treat patients with existing diplopia associated with mild or moderate to severe proptosis, respectively. Fatty or balanced decompressions can improve disfiguring exophthalmos in patients without existing diplopia associated with mild to moderate or severe proptosis, respectively. Inferomedial or 3-wall decompressions are preferred to address facial rehabilitation in patients associated with very severe proptosis but without preoperative diplopia.
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Affiliation(s)
- Anny M S Cheng
- Florida International University, Herbert Wertheim College of Medicine, Florida, USA
- Department of Surgery, Miller School of Medicine, University of Medicine, Miami, Florida, USA
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
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Association of variant on the promoter of cluster of differentiation 74 in graves disease and graves ophthalmopathy. Biosci Rep 2020; 40:225965. [PMID: 32744317 PMCID: PMC7432997 DOI: 10.1042/bsr20202072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/05/2022] Open
Abstract
The macrophage migration inhibitory factor (MIF)/cluster of differentiation 74 (CD74) plays a role in immunological functions. The present study aims to investigate whether single-nucleotide polymorphisms (SNPs) in the MIF and CD74 are risk factors for developing Graves ophthalmopathy (GO) in patients with Graves disease (GD). A case–control study enrolled 484 patients with GD (203 with and 281 without GO) and 1000 healthy individuals. SNPs were discriminated using real-time polymerase chain reaction. Hardy–Weinberg equilibrium, as well as frequencies of allele and genotype between GD patients with and without GO, were estimated using the Chi-square test. The effects of CD74 on adipocyte proliferation and differentiation were evaluated using 3T3-L1 preadipocytes. Quantitative DNA-immunoprecipitation was used to detect the binding capacity of NR3C1 and FOXP3 to A/G oligonucleotides. The results showed that individuals carrying the GG genotype at rs2569103 in the CD74 had a decreased risk of developing GD (P=3.390 × 10−11, odds ratio (OR) = 0.021, 95% confidence interval (CI) = 0.003–0.154); however, patients with GD carrying the AG genotype at rs2569103 in the CD74 had an increased risk of developing GO (P=0.009, OR = 1.707, 95% CI = 1.168–2.495). The knockdown of CD74 reduced adipocyte proliferation and differentiation. NR3C1 had a higher affinity for A, whereas FOXP3 had a higher affinity for G of rs2569103. The results suggested the existence of a link between the genetic variation of CD74 promoter and the risk for developing GD and GO, which should be considered in clinical practice.
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Pradhan A, Ganguly A, Naik MN, Nair AG, Desai S, Rath S. Thyroid eye disease survey: An anonymous web-based survey in the Indian subcontinent. Indian J Ophthalmol 2020; 68:1609-1614. [PMID: 32709788 PMCID: PMC7640870 DOI: 10.4103/ijo.ijo_1918_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the current practice patterns in the treatment of thyroid eye disease (TED) in Indian subcontinent through a web-based survey of members of Oculoplastics Association of India (OPAI). Methods This was an online web-based questionnaire survey disseminated via monkeysurvey.com to all ratified active members of OPAI between May 1, 2016 and June 30, 2016. Questions encompassed the background, training, region, and experience of oculoplastic surgeons along with the management protocol of TED. Results Of the 435 emails sent to OPAI members, 9 bounced and 180 (42.3%) responded within the study period. A large majority (96%) of respondents were oculoplastic surgeons practicing in India and the remaining practiced within South-East Asia. Two-thirds of respondents were oculoplastic surgeons with less than 10 years of clinical experience; 82% were fellowship trained in Oculoplasty. Almost all (99%) favored a multidisciplinary management of TED. A large majority routinely grade the severity (89%) and activity (87%) of disease before management. While corticosteroid remained the treatment of choice, 54% preferred immune-modulators as the second-line of therapy for recalcitrant TED. Three-quarters did not use orbital radiotherapy as a management modality in active TED owing to concerns over its efficacy and/or safety. Conclusion The survey gives useful insights to the practice patterns of TED management in Indian subcontinent. Multidisciplinary approach and grading of disease severity and activity were the rule rather than exception among OPAI members. Immune modulation was the preferred steroid-sparing agent in recalcitrant disease. Orbital radiotherapy was an uncommon treatment choice.
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Affiliation(s)
- Anuradha Pradhan
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
| | - Anasua Ganguly
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, KVC Campus, Vijayawada, Andhra Pradesh, India
| | - Milind N Naik
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Akshay Gopinathan Nair
- Department of Oculoplastic Surgery and Ocular Oncology: Aditya Jyot Eye Hospital, Wadala, Mumbai, Maharashtra, India
| | - Savari Desai
- P.D Hinduja National Hospital, Mahim and Hinduja Healthcare Surgical, Mumbai, Maharashtra, India
| | - Suryasnata Rath
- Ophthalmic Plastic Surgery and Ocular Oncology Services, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, India
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Özdemir A, Şahan MH, Asal N, İnal M, Güngüneş A. Evaluation of the medial rectus muscle and optic nerve using strain and shear wave elastography in Graves' patients. Jpn J Radiol 2020; 38:1028-1035. [PMID: 32638278 DOI: 10.1007/s11604-020-01014-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to describe the elastic properties of the medial rectus muscle and optic nerve in Graves' patients without clinically apparent ophthalmopathy using strain elastography (SE) and shear wave elastography (SWE) and to determine whether these elastic properties could be used to aid in the diagnosis of the medial rectus muscle or optic nerve involvement. MATERIALS AND METHODS Thirty participants diagnosed with Graves' disease without ophthalmopathy and 30 healthy volunteers (control group) were prospectively examined between November 2018 and August 2019. SE and SWE findings in both groups were compared using the χ2 test and the independent samples t test. RESULTS A statistically significant softening of the medial rectus muscle was observed in the SE patterns of the Graves' patients (p = 0.009). A statistically appreciable distinction was observed between the medial rectus muscle (7.64 ± 2.1 and 9.20 ± 1.7 kPa, p = 0.000) and the optic nerve (8.35 ± 2.8 and 9.37 ± 1.5 kPa, p = 0.019) in the SWE modulus of the Graves' patients and healthy volunteers. CONCLUSION SE and SWE can be used to identify structural alterations to the medial rectus muscle and optic nerve before clinically apparent Graves' ophthalmopathy has developed.
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Affiliation(s)
- Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey.
| | - Mehmet H Şahan
- Faculty of Medicine, Radiology Department, Gaziantep University, Gaziantep, Turkey
| | - Neşe Asal
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey
| | - Mikail İnal
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey
| | - Aşkın Güngüneş
- Faculty of Medicine, Endocrinology and Metabolism Department, Kirikkale University, Kirikkale, Turkey
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Evaluation of medical and surgical decompression in patients with dysthyroid optic neuropathy. Eye (Lond) 2020; 34:1702-1709. [PMID: 32366997 PMCID: PMC7608314 DOI: 10.1038/s41433-020-0897-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/08/2020] [Accepted: 04/14/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of steroid-pulse therapy and three-wall orbital decompression in patients with dysthyroid optic neuropathy (DON). METHODS Twenty-five patients (46 eyes) with a diagnosis of DON between 2008 and 2015 were included in the study. The first group (7 patients, 16 eyes) consisted of patients with a steroid-pulse treatment only and the second group (18 patients, 30 eyes) included patients with medical and surgical decompression. RESULTS Twenty patients were female; five patients were male. After the diagnosis of DON, all patients were treated with steroid-pulse treatment (intravenous 500 mg prednisolon twice/week for 4 weeks, 250 mg twice/week for 2 weeks) as a first-line treatment (medical decompression). In 30 eyes (18 patients) out of 46 eyes, (25 patients) an orbital decompression was needed to preserve the optic nerve function. In those therapy-resistant cases (surgical decompression group), the orbital decompression led to statistically significant improvements in best-corrected visual acuity (BCVA), protan and tritan value of the color vision (p = 0.007, p < 0.0001, p = 0.019, respectively, comparison of first visit to last visit). CONCLUSION According to our data, the mild cases of DON with better initial visual acuity (in our case series mean: 0.3 logMAR) seem to respond well to steroid treatment. However, therapy-resistant cases with an impaired initial BCVA (in our case series, mean: 0.6 logMAR) seem to need the surgery to preserve the optic nerve function. In conclusion, this retrospective study confirms the effectiveness of surgical decompression in therapy-resistant cases of DON.
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Expression of Collagen (Types I, III, and V), HSP47, MMP-2, and TIMP-1 in Retrobulbar Adipose Tissue of Patients with Thyroid-Associated Orbitopathy. J Ophthalmol 2020; 2020:4929634. [PMID: 32377419 PMCID: PMC7195673 DOI: 10.1155/2020/4929634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
Objective This study aimed to investigate the expression of collagen (types I, III, and V), heat shock protein 47 (HSP47), matrix metalloproteinase-2 (MMP-2), and tissue inhibitors of metalloproteinase-1 (TIMP-1) in the retrobulbar adipose tissues of patients with thyroid-associated orbitopathy (TAO). Materials and Methods The retrobulbar adipose tissues were collected from 4 TAO patients undergoing orbital decompression and 4 ocular enucleation patients with atrophic eyeball caused by ocular trauma between May 2019 and September 2019. Masson staining was performed to analyze the differences in collagen expression and degree of histologic fibrosis in each sample. The protein expressions of collagen (types I, III, and V), HSP47, MMP-2, and TIMP-1 were determined by western blotting. The data of western blotting were analyzed using SPSS version 17.0, with independent t-tests. Results The results of Masson staining showed that the expression of collagen fibers in the TAO group was significantly higher than that in the control group, and the fibers were diffuse and irregular in distribution. The expression level of collagen (types I, III, and V), HSP47, MMP-2, and TIMP-1 in the TAO group were significantly higher than that in the control group (P < 0.05). Conclusion The proliferation and fibrosis of retrobulbar adipose tissue in TAO patients might be related to the increased expression of collagen (types I, III, and V) and HSP47 and decreased degradation of extracellular matrix.
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Starks VS, Reinshagen KL, Lee NG, Freitag SK. Visual field and orbital computed tomography correlation in dysthyroid optic neuropathy due to thyroid eye disease. Orbit 2020; 39:77-83. [PMID: 31057005 DOI: 10.1080/01676830.2019.1600150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The pathogenesis of dysthyroid optic neuropathy (DON) in thyroid eye disease (TED) is thought to be compression of the apical optic nerve by hypertrophied extraocular muscles. We correlated worsening DON to the area occupied by extraocular muscles.Methods: Records of adults with TED DON evaluated from 1/1/2013 to 1/1/2018 were retrospectively reviewed. Each patient's visual field with the worst mean deviation (MD) was selected. Orbit CT scans were reviewed. Reformatted oblique coronal images were created perpendicular to the optic nerve. The cross-sectional area (CSA) of the orbit and each muscle group was measured and expressed as ratios of the CSA of the orbital apex. Univariate and multivariate analysis was performed for predictors of HVF MD.Results: 34 orbits with TED DON were analyzed. On orbital CT, the superior muscle complex occupied 15% of the apex (range 6-26%), inferior 18% (range 6-33%), lateral 10% (range 4-18%), medial 17% (range 8-27%), and all combined 61% (range 28-80%). Increasing total muscle area and superior complex area correlated with worsening MD. In multivariate linear regression, the superior muscle complex remained a significant predictor of MD (p = 0.01) over total muscle area (p = 0.25).Conclusions: Enlargement of extraocular muscles is common in TED, but DON occurs in only 6%. Our findings demonstrate that as DON worsens, as quantified by visual field MD, the superior muscle complex crowds the apex. This is consistent with the typical inferior visual field findings seen in TED DON. Hypertrophy of the superior rectus and levator palpabrae superioris complex may be predictive of worsening DON.
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Affiliation(s)
- Victoria S Starks
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | | | - Nahyoung G Lee
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Serum Vitamin D Deficiency Is an Independent Risk Factor for Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2020; 36:17-20. [DOI: 10.1097/iop.0000000000001437] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Paik JS, Kim SE, Kim JH, Lee JY, Yang SW, Lee SB. Insulin-like growth factor-1 enhances the expression of functional TSH receptor in orbital fibroblasts from thyroid-associated ophthalmopathy. Immunobiology 2019; 225:151902. [PMID: 31899052 DOI: 10.1016/j.imbio.2019.151902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/12/2019] [Accepted: 12/24/2019] [Indexed: 01/09/2023]
Abstract
Thyroid-associated ophthalmopathy (TAO), an autoimmune disease, occurs in approximately 50 % of patients with Graves' hyperthyroidism. Thyroid-stimulating hormone receptor (TSHR) that is expressed in orbital fibroblasts is the autoimmune target in the development of TAO. In addition to thyroid-stimulating immunoglobulin (TSI), insulin-like growth factor (IGF)-1 is also involved in the development of TAO. IGF-1 has been reported to potentiate the effects of thyroid-stimulating hormone (TSH) and TSI on TSHR signaling. In the current study, we investigated the effects of IGF-1 on the cell surface expression of the functional TSHR and its possible mechanism of action in human orbital fibroblasts. Our results show that orbital fibroblasts from the TAO patients expressed higher levels of IGF-1 receptor (IGF-R), compared to control subjects. Treatment with IGF-1 enhanced the expression of surface TSHR in orbital fibroblasts from TAO patients, but not from control subjects. In addition, treatment with IGF-1 increased the level of TSHR at both the protein and mRNA levels. Furthermore, pre-treatment with IGF-1 potentiated TSH-induced cAMP production, compared to cells that were treated with only TSH. Our results also show that pre-treatment with cycloheximide, an inhibitor of mRNA translation, partially, but not completely, inhibited the expression of TSHR on the cell surfaces of orbital fibroblasts from TAO patients. These collective results show that IGF-1enhances the cell surface expression of functional TSHR, not only by increasing TSHR expression, but also by inducing TSHR translocation to the plasma membrane in orbital fibroblasts from TAO.
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Affiliation(s)
- Ji Sun Paik
- Department of Ophthalmology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Kim
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Young Lee
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suk-Woo Yang
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong-Beom Lee
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Liu D, Xu X, Wang S, Jiang C, Li X, Tan J, Deng Z. 99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves' ophthalmopathy patients. Int Ophthalmol 2019; 40:553-561. [PMID: 31792849 DOI: 10.1007/s10792-019-01213-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/28/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Distinguishing between the active and inactive stages of Graves' ophthalmopathy (GO) is essential for making treatment decisions. 99mTc-DTPA SPECT/CT is sensitive in identifying inflammation in extraocular muscles of GO patients, which we designate 99mTc-DTPA-active. This study aimed to evaluate the response of 99mTc-DTPA-active GO patients to local immunosuppressive therapy. MATERIALS AND METHODS Sixty-four 99mTc-DTPA-active GO patients (89 eyes) were retrospectively analyzed. Forty-five patients (64 eyes) received repeated peribulbar triamcinolone injection, and 19 patients (25 eyes) received no immunosuppressive treatment. Ophthalmological assessment, including clinical activity score, eyelid retraction, eyelid aperture, proptosis, diplopia, and ocular mobility, was recorded before and after treatment. RESULTS Compared with untreated patients, the clinical activity score decreased significantly (P < 0.001) while eye symptoms (soft-tissue swelling and eyelid retraction and aperture) improved significantly (P = 0.02, P < 0.001, P < 0.001, respectively) in treated patients after six months. The inferior and medial recti were significantly smaller (P < 0.001, P < 0.001, respectively), and 99mTc-DTPA uptake in the two recti was significantly less (P = 0.001, P = 0.01, respectively) in treated patients than in untreated patients after 3 months. CONCLUSION Clinical activity score of < 3 does not indicate inactive GO, as revealed with 99mTc-DTPA SPECT/CT. Patients with 99mTc-DTPA-active GO can improve the symptoms with peribulbar triamcinolone injection.
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Affiliation(s)
- Dan Liu
- Department of Ophthalmology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Xueliang Xu
- Department of Ophthalmology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Sha Wang
- Department of Ophthalmology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Chengzhi Jiang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, China
| | - Xinhui Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, China
| | - Jia Tan
- Department of Ophthalmology, Xiangya Hospital Central South University, 87 Xiangya Road, Changsha, 410008, China.
| | - Zhihong Deng
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, China.
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Barac A, Knerer B, Neuchrist C, Sacu GS, Peric A, Mueller CA, Erovic BM. Long-term improvement of clinical symptoms after endoscopic sinus surgery in patients suffered from endocrine ophthalmopathy and orbital complications of rhinosinusitis. Acta Otolaryngol 2019; 139:876-880. [PMID: 31460819 DOI: 10.1080/00016489.2019.1648868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Rhinosinusitis may cause serious complications, such as secondary orbital infections, resulting in expansion and erosion of process through the orbital wall. Aims: The aim is to evaluate long-term outcome of ESS in patients suffered from endocrine ophthalmopathy and orbital complications of rhinosinusitis. Material and methods: Thirteen patients with loss of vision, endocrine ophthalmopathy and orbital complication of rhinosinusitis were treated by ESS. Preoperative and postoperative vision was rated by best-corrected visual acuity (BCVA) testing. Nine (69%) have been reinvestigated after 6 years by ophthalmology examination and 10-point scale for assessment of clinical symptoms. Results: The mean BCVA significantly increased after surgery comparing to results before surgery (0.84, 0.62; respectively) (p = .007). The mean values of 10-point scale for subjective assessment of symptoms 6 years after surgery were: headache 2.11, sinonasal pressure 1.72, subjective estimation of vision quality on the affected eye was 7.33 and olfaction 7.66. None of the patients developed impairment of vision loss in postoperative period. Conclusions: Long-term outcome of ESS showed decreased symptoms in patients who had endocrine ophthalmopathy and orbital complication of rhinosinusitis. Significance: ESS has numerous advantages for patients with orbital complication and vision loss comparing to conservative treatment and should be considered even in abscess absence.
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Affiliation(s)
- Aleksandra Barac
- Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Birgit Knerer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Csilla Neuchrist
- Department of Otorhinolaryngology, Head and Neck Surgery, Landeskrankenhaus Mistelbach, Mistelbach, Austria
| | - Gülhan S. Sacu
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Aleksandar Peric
- Department of Otorhinolaryngology, Faculty of Medicine, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Christian A. Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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Human placenta-derived mesenchymal stem cells ameliorate orbital adipogenesis in female mice models of Graves' ophthalmopathy. Stem Cell Res Ther 2019; 10:246. [PMID: 31399042 PMCID: PMC6688254 DOI: 10.1186/s13287-019-1348-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/03/2019] [Accepted: 07/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Graves’ ophthalmopathy (GO) is a complication of Graves’ disease (GD), in which orbital connective tissues become inflamed and increase in volume and orbital fibroblasts within the orbital fat and extraocular muscles differentiate into adipocytes in vitro when stimulated by hormones, several cytokines, and growth factors including TSH, IGF-1, IL-1, interferon γ, and platelet-derived growth factor. Human placental mesenchymal stem cells (hPMSCs) have immunomodulatory effects in disease pathogenesis. Although a number of studies have reported that hPMSCs can elicit therapeutic effects, these are not sufficient. Therefore, we constructed a GO animal model in order to find out the hPMSCs recovery effect. Methods We investigated their anti-adipogenic effects in in vitro cultures of orbital fibroblasts established from GO patients. Primary orbital fibroblasts were exposed to differentiation medium for 10 days. After being co-cultured with hPMSCs, the characteristics of orbital fibroblast were determined by Oil Red O stain and real-time PCR. Then, we explored the in vivo regulatory effects of hPMSCs in an experimental mouse model of GO. We developed the GO mouse model using immunization by leg muscle electroporation of pTriEx1.1Neo-hTSHR A-subunit plasmid. Human PMSC injection was performed into the left orbit. We also analyzed the effects of hPMSCs in the GO animal model. Result We found that hPMSCs inhibited a lipid accumulation and activated factors, such as ADIPONECTIN, PPARγ, C/EBPα, and TGFβ2 genes in adipogenesis-induced primary orbital fibroblasts from GO patients. Moreover, hPMSCs were highly effective at ameliorating adipogenesis in the orbital tissue of the model. Conclusion These data indicate that hPMSCs recover pathogenic activation of orbital fibroblasts in animals undergoing experimental GO and confirm the feasibility of applying hPMSCs as a novel treatment for GO patients.
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Fok JS, Katelaris CH. Angioedema Masqueraders. Clin Exp Allergy 2019; 49:1274-1282. [PMID: 31310036 DOI: 10.1111/cea.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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Koolstra K, Beenakker JM, Koken P, Webb A, Börnert P. Cartesian MR fingerprinting in the eye at 7T using compressed sensing and matrix completion-based reconstructions. Magn Reson Med 2019; 81:2551-2565. [PMID: 30421448 PMCID: PMC6519255 DOI: 10.1002/mrm.27594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To explore the feasibility of MR Fingerprinting (MRF) to rapidly quantify relaxation times in the human eye at 7T, and to provide a data acquisition and processing framework for future tissue characterization in eye tumor patients. METHODS In this single-element receive coil MRF approach with Cartesian sampling, undersampling is used to shorten scan time and, therefore, to reduce the degree of motion artifacts. For reconstruction, approaches based on compressed sensing (CS) and matrix completion (MC) were used, while their effects on the quality of the MRF parameter maps were studied in simulations and experiments. Average relaxation times in the eye were measured in 6 healthy volunteers. One uveal melanoma patient was included to show the feasibility of MRF in a clinical context. RESULTS Simulation results showed that an MC-based reconstruction enables large undersampling factors and also results in more accurate parameter maps compared with using CS. Experiments in 6 healthy volunteers used a reduction in scan time from 7:02 to 1:16 min, producing images without visible loss of detail in the parameter maps when using the MC-based reconstruction. Relaxation times from 6 healthy volunteers are in agreement with values obtained from fully sampled scans and values in literature, and parameter maps in a uveal melanoma patient show clear difference in relaxation times between tumor and healthy tissue. CONCLUSION Cartesian-based MRF is feasible in the eye at 7T. High undersampling factors can be achieved by means of MC, significantly shortening scan time and increasing patient comfort, while also mitigating the risk of motion artifacts.
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Affiliation(s)
- Kirsten Koolstra
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
| | - Jan‐Willem Maria Beenakker
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
- OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Andrew Webb
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
| | - Peter Börnert
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
- Philips ResearchHamburgGermany
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Abstract
BACKGROUND Radioactive iodine-131 (RAI) is an established treatment for patients with Graves' hyperthyroidism. RAI is reported to be associated with a 20-30% incidence of development or exacerbation of Graves' ophthalmopathy (GO). This study compares the progression of GO in patients who had evidence or no evidence of GO before RAI therapy. PATIENTS AND METHODS Forty-eight patients were studied. One group had no evidence whereas the other group had evidence of GO before RAI treatment. All underwent RAI therapy. Group A (27 patients, 18 women, nine men, age: 19-68 with a mean of 49 years) had pre-existing exophthalmos. Group B consisted of 21 patients (13 women, eight men, age: 30-63 with a mean of 43 years) developed exophthalmos after treatment. All patients underwent RAI therapy and followed by ophthalmologists. RESULTS The average administered dose in group A was 24.3 mCi (range: 10-36.2 mCi) compared with group B: 25.4 mCi (range: 13-35.9 mCi), P=0.60. Ten (37%) of the 27 patients in group A experienced worsening of symptoms post-treatment. There was no significant difference between the administered dose of RAI in patients with worsening symptoms, 25.1 mCi versus patients with stable symptoms, 24.5 mCi (P=0.82). However, group A developed GO symptoms earlier than group B (4.5 vs. 9.5 months), P=0.02. CONCLUSION RAI is known to exacerbate ophthalmopathy. Our study showed it was not dose-dependent. Patients without a previous history of GO were observed to have a significantly delayed period for the development of symptoms.
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48
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Chen Q. The expression of interleukin-15 and interleukin-17 in tears and orbital tissues of Graves ophthalmopathy patients. J Cell Biochem 2018; 120:6299-6303. [PMID: 30565709 DOI: 10.1002/jcb.27916] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/25/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to study the levels of interleukin (IL)-15 and IL-17 in tears and orbital tissues of the patients with the Graves ophthalmopathy (GO) (active and inactive stages) and in controls. METHODS Twenty-four active GO patients (CAS ≥ 3/7) were collected in our research. All patients were treated with corticosteroids during the therapy process (4-15 months) and developed into the inactive phase (CAS ≤ 2/7). The tear samples were gathered from inactive and active stages of patients with GO and sex-matched and age-matched controls (volunteers, n = 24) for the enzyme-linked immunosorbent assay measurement of IL-15 and IL-17. The orbital tissues were collected from inactive stage of patients with GO and healthy volunteers for the analysis of IL-15 and IL-17 positive cells using the immunohistochemical analysis. RESULTS In comparison with the volunteers, significant upregulation of IL-15 and IL-17 were identified in tears of active (P < 0.05) and inactive patients with GO ( P < 0.01). Compared with inactive patients with GO, the levels of IL-15 and IL-17 in the tears were obviously higher than those in the active patients with GO. In addition, higher expression of IL-15 and IL-17 positive cells were found in the orbital organization of inactive patients with GO compared with volunteers. CONCLUSION The differences in IL-15 and IL-17 expression between GO patients (active and inactive stages) and controls suggested both IL-15 and IL-17 expression were significantly correlated with thyroid-associated ophthalmopathy pathogenesis and development.
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Affiliation(s)
- Qun Chen
- Department of Ophthalmology, Shanghai Gongli Hospital, Shanghai, China
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49
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Ediriwickrema LS, Korn BS, Kikkawa DO. Thyroid-Related Orbitopathy, Restrictive Strabismus, Dermopathy, and Acropachy. JAMA Ophthalmol 2018; 136:e183217. [PMID: 30543354 DOI: 10.1001/jamaophthalmol.2018.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lilangi S Ediriwickrema
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego
| | - Bobby S Korn
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Diego
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego.,Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Diego
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50
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Abstract
BACKGROUND Thyroid eye disease (TED) is an autoimmune disorder that constitutes a major clinical and therapeutic challenge. Current treatment options for moderate-to-severe TED include immunotherapy, orbital radiotherapy and decompression surgery. Limited drugs of proven efficacy are available for the treatment of people with TED. Given the role in the pathogenesis of TED of interleukin (IL)-6 expression in adipocytes, fibroblasts and macrophages, the proposed theory is that inhibition of IL-6 by tocilizumab may be an effective treatment in TED by directly reducing the inflammatory response. In addition, there is an unmet need for a new treatment that can modify the natural course of the disease and reduce the incidence of late complications that can occur as a result of fibrosis following inflammation. OBJECTIVES To investigate the efficacy and harms of tocilizumab for the treatment of people with TED. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); MEDLINE Ovid; Embase Ovid; LILACS BIREME; OpenGrey; the ISRCTN registry; ClinicalTrials.gov; the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and the EU Clinical Trials Register. The date of the search was 31 July 2018. SELECTION CRITERIA We searched for trials of tocilizumab administered by intravenous infusion using any dosage regimen, compared with placebo or intravenous glucocorticoid therapy for people with TED. DATA COLLECTION AND ANALYSIS We planned to use standard methods recommended by Cochrane. The primary outcome was change in TED score (as defined by investigators). Secondary outcomes included measurement of the following parameters: change in proptosis, change in extraocular motility, change in palpebral aperture measurements, number of relapses, development of optic neuropathy and change in quality of life score. We planned to measure these outcomes at three months (range two to six months) and 12 months (range six to 18 months) post-treatment. Adverse outcomes included any adverse effects identified in the trials at any time point. MAIN RESULTS No studies met the inclusion criteria of this review. We found one randomised, placebo-controlled, double masked study (NCT01297699). This study plans to evaluate the efficacy and harms of tocilizumab administration in people with moderate-to-severe or sight-threatening graves' ophthalmopathy (GO), that had not responded adequately to treatment with intravenous corticosteroid pulses. It was completed in December 2015 and will be assessed for inclusion in the review when data become available. AUTHORS' CONCLUSIONS There is currently no evidence from randomised controlled trials evaluating the efficacy and harms of tocilizumab for the treatment of people with TED.
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Affiliation(s)
- Shirin Hamed Azzam
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Swan Kang
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | | | - Daniel G Ezra
- Moorfields Eye Hospital NHS Foundation TrustMoorfields and UCL Institute of Ophthalmology BMRCCity RoadLondonUKEC1V 2PD
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