AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patient...AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P<0.001).In the TED-strabismus group,20%of patients had abnormal head posture(AHP),while none were identified in the TED group(P=0.029).Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy(19%vs 8.1%)and exposure keratopathy(4.8%vs 1.8%)in the TED group than in the TED-strabismus group,the difference did not reach statistical significance(P>0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.展开更多
Background: Thyroid Eye Disease (TED) is known to alter tissues of the orbital cavity, including the optic nerve. However, its effect on measured global Retinal Nerve Fiber Layer (gRNFL) is not well elucidated. This c...Background: Thyroid Eye Disease (TED) is known to alter tissues of the orbital cavity, including the optic nerve. However, its effect on measured global Retinal Nerve Fiber Layer (gRNFL) is not well elucidated. This case evaluates the effect of teprotumumab on gRNFL in a patient with moderate TED. Observations: A 60-year-old female with controlled ocular hypertension and moderate TED received 8 standard IV teprotumumab infusions. Comprehensive ocular evaluations were performed pre-, during-, and post-treatment. Bilateral gRNFL thickness decreased (10 m OD;12 m OS) at 4 months post-treatment start, persisting at 8 months, but recovered at 20 months. Conclusions and Importance: Teprotumumab treatment in patients with TED led to a transient bilateral decrease in gRNFL thickness, which was restored to baseline levels with no adverse events reported. Monitoring gRNFL changes in teprotumumab-treated patients is crucial as gRNFL thinning indicates retinal ganglion cell damage. Teprotumumabs ability to dampen the IGF-IR inflammatory cascade may have reduced retinal inflammation, leading to recovery.展开更多
Thyroid eye disease(TED)can cause incomitant strabismus with muscle restriction,resulting in diplopia and patient discomfort and discontent.Surgical correction of TED-associated restrictive strabismus has been attempt...Thyroid eye disease(TED)can cause incomitant strabismus with muscle restriction,resulting in diplopia and patient discomfort and discontent.Surgical correction of TED-associated restrictive strabismus has been attempted,with fixed and adjustable suture success rates varying from 38%to 82%.This paper reviews five articles that explored the utility of the intraoperative relaxed muscle positioning(IRMP)technique in patients with restrictive strabismus due to TED.While IRMP is a useful technique for addressing TED-related strabismus and is effective in patients with incomitant strabismus,disease reactivation,staged and unplanned surgeries,combined horizontal and vertical deviations,and previous orbital decompression surgeries,it is probable that this approach can be utilized in children with restrictive types of strabismus.Therefore,further studies are required.展开更多
Thyroid eye disease(also known as Graves’ophthalmopathy)is a complex orbital inflammatory disease,which can be sight threatening,debilitating and disfiguring.This overview discusses the epidemiology,risk factors,path...Thyroid eye disease(also known as Graves’ophthalmopathy)is a complex orbital inflammatory disease,which can be sight threatening,debilitating and disfiguring.This overview discusses the epidemiology,risk factors,pathogenesis,presentation,ophthalmic clinical features,investigations and treatment of thyroid eye disease.展开更多
Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye dise...Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye disease. Aim: This study was conducted for the profile of ocular manifestation in Thyroid Eye Disease (TED). Methodology: A cross-sectional study of 117 cases of thyroid dysfunction was carried out at BP Koirala Institute of Health System, out of which 84 (71.79%) cases had ocular manifestation. They were evaluated and analyzed in detail and the characteristics documented included patient’s demography, ocular and systemic history and as well as ocular examination and some of the systemic and laboratory findings. Results: In this study, mean age of presentation of TED was 39.7 years. 59 patients were female and 25 were male. The maximum patients of both sexes were in the fourth decade of their lives. The common lid signs were lid retraction and lid lag. Proptosis was seen in 33.3% of cases out of which 68% had bilateral proptosis. Corneal ulcer was seen in 7.1% and optic neuropathy in 1.2% of cases. In 27.3% of cases there was elevation of IOP. Dry eye was seen in 61.9% of cases and POAG seen in 8.3% of cases. In the study population 75% were hyperthyroiditic, 16.7% were hypothyroiditic and 8.3% were in euthyroid state. Conclusion: Female was more commonly affected. The maximum number of patients of both sexes was in the fourth decade of their lives. Hyperthyroidism patient had greater chance of ocular manifestation.展开更多
AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum ...AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum antibodies and the severity of TED.METHODS:A total of 85 participants were enrolled.All participants underwent ophthalmology and endocrinology examinations.Subfoveal choroidal thickness(SFCT),superficial(s)and deep(d)foveal avascular zone(FAZ)area,mean(m)and central(c)superficial vascular density(SVD),deep vascular density(DVD)measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography(OCT)/OCT angiography(OCTA)DRI OCT Triton.Multiple linear regression analysis was used to explore the associations between SFCT,FAZ area,SVD,DVD and the relevant factors of TED.RESULTS:Those with active TED patients had higher c-DVD and m-DVD levels(P<0.05),however there is no statistically significant difference in SFCT between active and stable TED patients.Among the serum antibodies,it was observed that s-FAZ and d-FAZ increased,c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies(TRAB)level,whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin(hTG).There was no significant difference in SFCT,FAZ,SVD and DVD measurement at gender,between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma.CONCLUSION:The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density.It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.展开更多
AIM： To investigate the positive rate and types of cells that express Epstein-Barr virus-encoded small RNAs （EBERs） and to determine the distribution of EBER-expressing cells in idiopathic orbital inflammatory pseu...AIM： To investigate the positive rate and types of cells that express Epstein-Barr virus-encoded small RNAs （EBERs） and to determine the distribution of EBER-expressing cells in idiopathic orbital inflammatory pseudotumor （IOIP） tissues. METHODS： We retrospectively examined 40 archived paraffin specimens from two teaching hospitals in Southern China between January 2007 and January 2015 that were pathologically determined to exhibit IOIP. Eleven concurrent paraffin specimens of thyroid-associated ophthalmopathy （TAO） composed the control group. In situ hybridization was performed to detect EBERs. Immunohistochemistry was employed to detect CD3, CD20, Vimentin, and smooth muscle actin （SMA）, and the positive rate, types of positive cells, and distribution and location of EBERs were evaluated. RESULTS： The positive expression rate of EBERs was 47.5% （19/40） in the IOIP group, which was significantly higher than that in the TAO group [0 （0/11）, P=-0.011]. in the IOIP group, the lymphocyte infiltrative subtype, fibrotic subtype, and mixed subtype exhibited EBER-positive rates of 57.1% （12121）, 12.5% （118）, and 54.5% （6/11）, respectively, and no significant differences were found between these subtypes （P=0.085）. Positive signals of EBERs were mainly present in medium-small lymphocytes between or around follicles and in the nuclei of activated immunoblasts （14/19）. CONCLUSION： The positive rate, types, and distribution of EBER-expressing cells in IOIP have been documented.These findings are conducive for a better understanding of the underlying mechanisms of Epstein-Barr virus infection in IOIP pathogenesis.展开更多
文摘AIM:To identify differences in clinical features between thyroid eye disease(TED)patients with and without strabismus.METHODS:This retrospective,single-center,consecutive case series study was conducted on TED patients who were determined to be surgical candidates.The patients’cohort were divided into two groups based on the presence or absence of strabismus.Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups.RESULTS:A total of 76 patients with TED were enrolled,including 58 males(76.3%)with a mean age of 52.68±10.45y.The 55 patients(male:female=2:1)were found to have TED with strabismus,while the remaining 21 patients(male:female=4:1)had TED without strabismus.There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus(OR=4.1,P=0.018)and they showed higher prevalence of proptosis(95.2%)than the TED strabismus group(63.6%,P<0.001).In the TED-strabismus group,20%of patients had abnormal head posture(AHP),while none were identified in the TED group(P=0.029).Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy(19%vs 8.1%)and exposure keratopathy(4.8%vs 1.8%)in the TED group than in the TED-strabismus group,the difference did not reach statistical significance(P>0.05).The most common types of strabismus were hypotropia(36%)and esotropia(29%),respectively.CONCLUSION:Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction,but a higher incidence of compensatory AHP.Identifying these differences may aid in risk stratification and early intervention for TED patients,particularly those at risk for restrictive strabismus.
文摘Background: Thyroid Eye Disease (TED) is known to alter tissues of the orbital cavity, including the optic nerve. However, its effect on measured global Retinal Nerve Fiber Layer (gRNFL) is not well elucidated. This case evaluates the effect of teprotumumab on gRNFL in a patient with moderate TED. Observations: A 60-year-old female with controlled ocular hypertension and moderate TED received 8 standard IV teprotumumab infusions. Comprehensive ocular evaluations were performed pre-, during-, and post-treatment. Bilateral gRNFL thickness decreased (10 m OD;12 m OS) at 4 months post-treatment start, persisting at 8 months, but recovered at 20 months. Conclusions and Importance: Teprotumumab treatment in patients with TED led to a transient bilateral decrease in gRNFL thickness, which was restored to baseline levels with no adverse events reported. Monitoring gRNFL changes in teprotumumab-treated patients is crucial as gRNFL thinning indicates retinal ganglion cell damage. Teprotumumabs ability to dampen the IGF-IR inflammatory cascade may have reduced retinal inflammation, leading to recovery.
文摘Thyroid eye disease(TED)can cause incomitant strabismus with muscle restriction,resulting in diplopia and patient discomfort and discontent.Surgical correction of TED-associated restrictive strabismus has been attempted,with fixed and adjustable suture success rates varying from 38%to 82%.This paper reviews five articles that explored the utility of the intraoperative relaxed muscle positioning(IRMP)technique in patients with restrictive strabismus due to TED.While IRMP is a useful technique for addressing TED-related strabismus and is effective in patients with incomitant strabismus,disease reactivation,staged and unplanned surgeries,combined horizontal and vertical deviations,and previous orbital decompression surgeries,it is probable that this approach can be utilized in children with restrictive types of strabismus.Therefore,further studies are required.
文摘Thyroid eye disease(also known as Graves’ophthalmopathy)is a complex orbital inflammatory disease,which can be sight threatening,debilitating and disfiguring.This overview discusses the epidemiology,risk factors,pathogenesis,presentation,ophthalmic clinical features,investigations and treatment of thyroid eye disease.
文摘Background: Thyroid eye disease represents an organ-specific autoimmune process that is usually associated with thyroid disease. Graves’ disease is the most common thyroid abnormality associated with thyroid eye disease. Aim: This study was conducted for the profile of ocular manifestation in Thyroid Eye Disease (TED). Methodology: A cross-sectional study of 117 cases of thyroid dysfunction was carried out at BP Koirala Institute of Health System, out of which 84 (71.79%) cases had ocular manifestation. They were evaluated and analyzed in detail and the characteristics documented included patient’s demography, ocular and systemic history and as well as ocular examination and some of the systemic and laboratory findings. Results: In this study, mean age of presentation of TED was 39.7 years. 59 patients were female and 25 were male. The maximum patients of both sexes were in the fourth decade of their lives. The common lid signs were lid retraction and lid lag. Proptosis was seen in 33.3% of cases out of which 68% had bilateral proptosis. Corneal ulcer was seen in 7.1% and optic neuropathy in 1.2% of cases. In 27.3% of cases there was elevation of IOP. Dry eye was seen in 61.9% of cases and POAG seen in 8.3% of cases. In the study population 75% were hyperthyroiditic, 16.7% were hypothyroiditic and 8.3% were in euthyroid state. Conclusion: Female was more commonly affected. The maximum number of patients of both sexes was in the fourth decade of their lives. Hyperthyroidism patient had greater chance of ocular manifestation.
文摘AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum antibodies and the severity of TED.METHODS:A total of 85 participants were enrolled.All participants underwent ophthalmology and endocrinology examinations.Subfoveal choroidal thickness(SFCT),superficial(s)and deep(d)foveal avascular zone(FAZ)area,mean(m)and central(c)superficial vascular density(SVD),deep vascular density(DVD)measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography(OCT)/OCT angiography(OCTA)DRI OCT Triton.Multiple linear regression analysis was used to explore the associations between SFCT,FAZ area,SVD,DVD and the relevant factors of TED.RESULTS:Those with active TED patients had higher c-DVD and m-DVD levels(P<0.05),however there is no statistically significant difference in SFCT between active and stable TED patients.Among the serum antibodies,it was observed that s-FAZ and d-FAZ increased,c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies(TRAB)level,whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin(hTG).There was no significant difference in SFCT,FAZ,SVD and DVD measurement at gender,between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma.CONCLUSION:The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density.It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.
基金Supported by the National Natural Science Foundation of China(No.81260149No.81360152+2 种基金No.81560162)Guangxi Natural Science Foundation(No.2016GXNSFAA380301)Youth Science Foundation of Guangxi Medical University(No.GXMUYSF2014040)
文摘AIM： To investigate the positive rate and types of cells that express Epstein-Barr virus-encoded small RNAs （EBERs） and to determine the distribution of EBER-expressing cells in idiopathic orbital inflammatory pseudotumor （IOIP） tissues. METHODS： We retrospectively examined 40 archived paraffin specimens from two teaching hospitals in Southern China between January 2007 and January 2015 that were pathologically determined to exhibit IOIP. Eleven concurrent paraffin specimens of thyroid-associated ophthalmopathy （TAO） composed the control group. In situ hybridization was performed to detect EBERs. Immunohistochemistry was employed to detect CD3, CD20, Vimentin, and smooth muscle actin （SMA）, and the positive rate, types of positive cells, and distribution and location of EBERs were evaluated. RESULTS： The positive expression rate of EBERs was 47.5% （19/40） in the IOIP group, which was significantly higher than that in the TAO group [0 （0/11）, P=-0.011]. in the IOIP group, the lymphocyte infiltrative subtype, fibrotic subtype, and mixed subtype exhibited EBER-positive rates of 57.1% （12121）, 12.5% （118）, and 54.5% （6/11）, respectively, and no significant differences were found between these subtypes （P=0.085）. Positive signals of EBERs were mainly present in medium-small lymphocytes between or around follicles and in the nuclei of activated immunoblasts （14/19）. CONCLUSION： The positive rate, types, and distribution of EBER-expressing cells in IOIP have been documented.These findings are conducive for a better understanding of the underlying mechanisms of Epstein-Barr virus infection in IOIP pathogenesis.
