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Tian H, Wang Y, Li J, Li H. Prognostic value of extraocular muscles for intraocular pressure in thyroid-associated ophthalmopathy patients. Quant Imaging Med Surg 2023; 13:5727-5736. [PMID: 37711835 PMCID: PMC10498208 DOI: 10.21037/qims-23-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/26/2023] [Indexed: 09/16/2023]
Abstract
Background Persistent increase in intraocular pressure (IOP) is often observed in eyes with thyroid-associated ophthalmopathy (TAO), which has irreversible effects on the visual function of patients. This retrospective cross-sectional study evaluated the value of magnetic resonance imaging (MRI) measurements of extraocular muscle (EOM) volume in prognosing IOP in patients with TAO. Methods This single-center study was conducted in Beijing Friendship Hospital (Beijing, China), a tertiary hospital. From 35 participants, 70 eyes (normal IOP group: 50 eyes; high IOP group: 20 eyes; random samples) were enrolled in this study. Basic data from patients were collected and compared using 2-sample t-tests and chi-squared tests. The volume of the EOM, orbit fat, and whole orbit were measured by orbital MRI. Moreover, proptosis, optic nerve (ON) sheath diameter, optic nerve angle (ONA), and gaze angle were additionally measured with MRI. These parameters were compared between the two groups using 2-sample t-tests and chi-squared tests. Before and after post-methylprednisolone therapy, the MRI data of 20 eyes were obtained and compared with a paired t-test. Peripapillary retinal nerve fiber layer (RNFL) thickness was obtained using an optical coherence tomography (OCT) scan. Spearman rank correlation analysis, logistic regression analysis, and receiver operating characteristic (ROC) curves were performed to evaluate the role of these factors in IOP changes. Results The EOM volume and axial and sagittal ONAs in the high-IOP group were significantly increased compared to the normal-IOP group (P<0.001, P=0.001, P=0.02, respectively). Logistic regression analysis indicate that the cutoff value for EOM volume for the diagnosis of high IOP was significantly larger than that of the other parameters except orbit volume (P=0.03, P=0.004, P=0.08, respectively). Spearman correlation analysis revealed a significant correlation between EOM volume and ON sheath diameter and average RNFL thickness (P=0.01, P=0.02, respectively). A paired t-test indicated a significant decrease of EOM volume and ON sheath diameter as well as a significant enlargement of the axial ONAs after methylprednisolone therapy (P=0.002, P=0.02, P=0.05, respectively). Conclusions EOM volume was an effective diagnostic factor for tracking IOP changes and ON patterns in patients with TAO. Methylprednisolone therapy is recommended for patients with TAO with secondary glaucoma to quickly reduce the EOM volume.
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Affiliation(s)
- Huiwen Tian
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Luo B, Liu R, Wang S, Hu W, Li Y, Tong B, Zhang H, Qi X. Utility of isolated-check visual evoked potential technique in dysthyroid optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2031-2040. [PMID: 36642765 PMCID: PMC10271890 DOI: 10.1007/s00417-023-05975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/13/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To analyze the utility of isolated-check visual evoked potential (icVEP) for discriminating between eyes with dysthyroid optic neuropathy (DON) and eyes with thyroid-associated ophthalmopathy (TAO) but not DON. METHODS Forty-three eyes with TAO but not DON (as non-DON), fifty-three eyes with DON, and sixty healthy eyes (as controls) were included. Comprehensive ophthalmic examinations, including best-corrected visual acuity, refraction, color vision test, intraocular pressure measurement, slit-lamp biomicroscopy, ophthalmoscopy, RAPD, exophthalmometry measurements, pVEP test, icVEP test, standard automated perimetry, and clinical activity score classification of TAO, as well as demographic information, were collected and analyzed. RESULTS In the DON group, the signal-to-noise ratio (SNR) value of icVEPs decreased significantly compared with that of the non-DON group as well as control (p < 0.05). The SNR values under 8%, 16% and 32% depth of modulation (DOM) were significantly negatively correlated with BCVA (p < 0.05, r = - 0.9 ~ - 0.6), papilledema (Y/N) (p < 0.05, r = - 0.8 ~ 0.4) and DON (Y/N) (p < 0.001, r = - 0.7 ~ - 0.5). The 8% DOM of icVEP had the largest area under the receiver operating characteristic curve (AUC) (0.842) for discriminating DON from non-DONs. Meanwhile, decision curve analysis (DCA) showed that patients clinically benefit most from 8% DOM of icVEP. Furthermore, the 8% DOM of icVEP combing with papilledema (Y/N) and BCVA (Model 1) has significantly larger AUC than the 8% DOM of icVEP (p = 0.0364), and has better clinical benefit in DCA analysis. CONCLUSIONS The SNR of 8% DOM from icVEP may represent a significant ancillary diagnostic method for DON detection. Furthermore, icVEP combined with papilledema (Y/N) and BCVA should be considered as a diagnostic model in future clinical practice.
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Affiliation(s)
- Ban Luo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
- Department of Ophthalmology, Wenchang People’s Hospital, Wenchang, 571321 China
| | - Rong Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Shanluxi Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Weikun Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Yunping Li
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011 Hunan China
| | - Boding Tong
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011 Hunan China
| | - Hong Zhang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Qiaokou District, No.1095, Jiefang Avenue, Wuhan, 430030 Hubei China
| | - Xin Qi
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, No.139, Renmin Middle Road, Changsha, 410011 Hunan China
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Chen Y, Tang R, Xiong W, Zhang F, Wang N, Xie B, Cao J, Chen Z, Ma C. RNA aptamers with specific binding affinity to CD40 (CD40Apt) represents a promising antagonist of the CD40-CD40L signaling for thyroid-associated ophthalmopathy (TAO) treatment in mouse. J Transl Med 2023; 21:396. [PMID: 37331977 DOI: 10.1186/s12967-023-04217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is the most common autoimmune inflammatory diseases of the orbit. The CD40-CD40L pathway has been regarded as a potential molecular mechanism contributing to the development and progression of TAO, and RNA aptamers with specific binding affinity to CD40 (CD40Apt) represents a promising inhibitor of the CD40-CD40L signaling in TAO treatment. In this study, CD40Apt was confirmed to specifically recognize mouse CD40-positive ortibtal fibroblast. Mouse orbital fibroblasts were isolated from TAO mice model orbital tissues and validated. In TGF-β-induced orbital fibroblast activation model in vitro, CD40Apt administration inhibited TGF-β-induced cell viability, decreased TGF-β-induced α-SMA, Collagen I, Timp-1, and vimentin levels, and suppressed TGF-β-induced phosphorylation of Erk, p38, JNK, and NF-κB. In TAO mice model in vivo, CD40Apt caused no significant differences to the body weight of mice; furthermore, CD40Apt improved the eyelid broadening, ameliorated inflammatory infiltration and the hyperplasia in orbital muscle and adipose tissues in model mice. Concerning orbital fibroblast activation, CD40Apt reduced the levels of CD40, collagen I, TGF-β, and α-SMA in orbital muscle and adipose tissues of model mice. Finally, CD40Apt administration significantly suppressed Erk, p38, JNK, and NF-κB phosphorylation. In conclusion, CD40Apt, specifically binds to CD40 proteins in their natural state on the cell surface with high affinity, could suppress mouse orbital fibroblast activation, therefore improving TAO in mice model through the CD40 and downstream signaling pathways. CD40Apt represents a promising antagonist of the CD40-CD40L signaling for TAO treatment.
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Affiliation(s)
- Yizhi Chen
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Renhong Tang
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wei Xiong
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Feng Zhang
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Nuo Wang
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Bingyu Xie
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jiamin Cao
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuokun Chen
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Chen Ma
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China
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Shao J, Huang X, Gao T, Cao J, Wang Y, Zhang Q, Lou L, Ye J. Deep learning-based image analysis of eyelid morphology in thyroid-associated ophthalmopathy. Quant Imaging Med Surg 2023; 13:1592-1604. [PMID: 36915314 PMCID: PMC10006102 DOI: 10.21037/qims-22-551] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/25/2022] [Indexed: 01/05/2023]
Abstract
Background We aimed to propose a deep learning-based approach to automatically measure eyelid morphology in patients with thyroid-associated ophthalmopathy (TAO). Methods This prospective study consecutively included 74 eyes of patients with TAO and 74 eyes of healthy volunteers visiting the ophthalmology department in a tertiary hospital. Patients diagnosed as TAO and healthy volunteers who were age- and gender-matched met the eligibility criteria for recruitment. Facial images were taken under the same light conditions. Comprehensive eyelid morphological parameters, such as palpebral fissure (PF) length, margin reflex distance (MRD), eyelid retraction distance, eyelid length, scleral area, and mid-pupil lid distance (MPLD), were automatically calculated using our deep learning-based analysis system. MRD1 and 2 were manually measured. Bland-Altman plots and intraclass correlation coefficients (ICCs) were performed to assess the agreement between automatic and manual measurements of MRDs. The asymmetry of the eyelid contour was analyzed using the temporal: nasal ratio of the MPLD. All eyelid features were compared between TAO eyes and control eyes using the independent samples t-test. Results A strong agreement between automatic and manual measurement was indicated. Biases of MRDs in TAO eyes and control eyes ranged from -0.01 mm [95% limits of agreement (LoA): -0.64 to 0.63 mm] to 0.09 mm (LoA: -0.46 to 0.63 mm). ICCs ranged from 0.932 to 0.980 (P<0.001). Eyelid features were significantly different in TAO eyes and control eyes, including MRD1 (4.82±1.59 vs. 2.99±0.81 mm; P<0.001), MRD2 (5.89±1.16 vs. 5.47±0.73 mm; P=0.009), upper eyelid length (UEL) (27.73±4.49 vs. 25.42±4.35 mm; P=0.002), lower eyelid length (LEL) (31.51±4.59 vs. 26.34±4.72 mm; P<0.001), and total scleral area (SATOTAL) (96.14±34.38 vs. 56.91±14.97 mm2; P<0.001). The MPLDs at all angles showed significant differences in the 2 groups of eyes (P=0.008 at temporal 180°; P<0.001 at other angles). The greatest temporal-nasal asymmetry appeared at 75° apart from the midline in TAO eyes. Conclusions Our proposed system allowed automatic, comprehensive, and objective measurement of eyelid morphology by only using facial images, which has potential application prospects in TAO. Future work with a large sample of patients that contains different TAO subsets is warranted.
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Affiliation(s)
- Ji Shao
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xingru Huang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Tao Gao
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jing Cao
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Qianni Zhang
- School of Electronic Engineering and Computer Science, Queen Mary University of London, London, UK
| | - Lixia Lou
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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Xie B, Xiong W, Zhang F, Wang N, Luo Y, Chen Y, Cao J, Chen Z, Ma C, Chen H. The miR-103a-3p/TGFBR3 axis regulates TGF-β-induced orbital fibroblast activation and fibrosis in thyroid-eye disease. Mol Cell Endocrinol 2023; 559:111780. [PMID: 36179941 DOI: 10.1016/j.mce.2022.111780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 02/03/2023]
Abstract
Molecular pathways that contribute to orbital fibroblast activation during thyroid-eye disease (TED) may promote TED progression. Non-coding RNAs, especially miRNAs, play a critical role in the pathogenesis of TED. In the present study, miR-103a-3p was dramatically upregulated and TGFBR3 was downregulated within TED orbital tissue samples and TGF-β-stimulated TED orbital fibroblasts. miR-103a-3p inhibition in TGF-β-stimulated TED orbital fibroblasts partially abolished TGF-β-induced fibrotic alterations, as manifested by the impaired fibroblast cell viability and decreased vimentin and fibronectin levels. miR-103a-3p directly targeted TGFBR3 in TED orbital samples and TGF-β-stimulated TED orbital fibroblasts. In TGF-β-stimulated TED orbital fibroblasts, TGFBR3 overexpression inhibited fibroblast cell viability and decreased vimentin and fibronectin levels. TGFBR3 overexpression partially attenuated the inhibitory effects of miR-103a-3p overexpression on TGFBR3 expression and the promotive effects of miR-103a-3p overexpression on TGF-β-induced fibrotic alterations. Under TGF-β stimulation, miR-103a-3p overexpression significantly promoted, whereas TGFBR3 overexpression inhibited the phosphorylation of Erk1/2, JNK, Smad2, and Smad3. TGFBR3 overexpression also partially abolished the effects of miR-103a-3p overexpression on Erk1/2, JNK, Smad2, and Smad3 phosphorylation. In conclusion, the miR-103a-3p/TGFBR3 axis regulated TGF-β-induced TED orbital fibroblast activation and fibrosis in TED, with the possible involvement of the Erk/JNK and TGF-β/Smad signaling pathways.
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Affiliation(s)
- Bingyu Xie
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Wei Xiong
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Feng Zhang
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China.
| | - Nuo Wang
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Yong Luo
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Yizhi Chen
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Jiamin Cao
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Zhuokun Chen
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Chen Ma
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Haiyan Chen
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, 410013, China
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Qi X, Luo B, Deng M, Cao J, Hou S, Xie Z, Tong B, Xiong W. Botox-A improve the thyroid-associated ophthalmopathy (TAO) orbital fibroblast activation through inhibiting the TGF-β/Smad signaling. Exp Eye Res 2022; 217:108971. [PMID: 35108585 DOI: 10.1016/j.exer.2022.108971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The activation of orbital fibroblasts can result in fibrosis, finally contributing to thyroid-associated ophthalmopathy (TAO) progression. Although the effect of BTX-A on the treatment of TAO-related strabismus and upper eyelid retraction has long been recognized in clinical work, the underlying mechanism of BTX-A improving TAO-related strabismus and upper eyelid retraction has not been uncovered yet. In the present study, we successfully isolated and authenticated normal and TAO orbital fibroblasts. Compared with PBS, BTX-A and TACA exerted similar inhibitory effects on TAO orbital fibroblast proliferation and ECM production. TGF-β stimulation induced the proliferation and ECM production by TAO orbital fibroblast, which was significantly inhibited by BTX-A or TACA treatment. Under TGF-β stimulation, the inhibitory effects of BTX-A or TACA treatment on TAO orbital fibroblast proliferation and ECM production were reversed by TGF-β/Smad signaling agonist SRI-011381. Collectively, BTX-A inhibited TGF-β-induced TAO orbital fibroblast activation through inhibiting the TGF-β/Smad signaling. Considering that TACA shows no satisfactory curative effects on symptoms closely related to the function of extraocular muscles, such as eye movement and diplopia, BTX-A might be a promising agent in TAO treatment.
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Affiliation(s)
- Xin Qi
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Mi Deng
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jiamin Cao
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Shiying Hou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Zhaoyu Xie
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Boding Tong
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
| | - Wei Xiong
- Department of Ophthalmology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
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Khataminia G, Ostadian F, Noroozzadeh M, Latifi M, Khataminia M. Acetazolamide and Thyroid-Associated Ophthalmopathy; a Preliminary Tested Hypothesis in a TertiaryReferral Center. Med Hypothesis Discov Innov Ophthalmol 2013; 2:109-12. [PMID: 24822231 PMCID: PMC4017632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
This study evaluated the effect of acetazolamide on thyroid-associated ophthalmopathy (TAO). Patients with a VISA classification index equal to or more than four were enrolled in the study and were randomly assigned into two groups. In both groups, treatment was initiated using prednisolone. Patients in the case group received acetazolamide tablets 250 mg daily in addition to prednisolone. Three months later, the VISA inflammatory score of patients in both groups were determined. Subsequent to intervention with acetazolamide, the VISA inflammatory score of patients in the case group were reduced as follows; orbital pain (57.1% versus 41.7%, P=0.736), eyelid edema (42.8% versus 27.1%, P=0.67), chemosis (53.3% versus 33%, P=0.31), injection of the eyelids (60% versus 41.6%, P=0.342), and conjunctival injection (50% versus 46.13%, P=0.73). However, these reductions were not statistically significant when compared with those observed in the control group (P=0.246). In conclusion, the effect of acetazolamide on all the parameters of the VISA inflammatory score was examined independently. All patients in the case group revealed a reduction in VISA inflammatory score following intervention. However, these reductions were not statistically significant. Further studies with large sample sizes are required.
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Affiliation(s)
- Gholamreza Khataminia
- Department of Ophthalmology, Ophthalmology Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farshad Ostadian
- Department of Ophthalmology, Ophthalmology Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Noroozzadeh
- Department of Ophthalmology, Ophthalmology Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahmoud Latifi
- Department of Health, Diabetes Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoud Khataminia
- Department of Ophthalmology, Ophthalmology Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran
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