Is concomitant treatment with steroids and radiotherapy more favorable than sequential treatment in moderate-to-severe graves orbitopathy?

Defect Engineering in GO Membranes - Tailoring Size and Oxidation Degree of Nanosheet for Enhanced Pore Channels

Graphene Oxide (GO) membrane has been extensively applied in the field of water purification and membrane separation processes. While the solute molecule transport in GO membranes encompasses interlayer channels, edge defects, and in-plane crack-like holes, the significance of edge defects or crack-like pores in ultrathin membranes is often overlooked. In our study, we focused on the construction of short-range channel GO membranes with varied defect structures by modulating the transverse size of the porous nanosheets. GO nanosheets with different sizes were procured through high-energy γ-irradiation combined with centrifugation. Notably, the large-sized porous GO nanosheets (L-pGO) exhibit a consistent structure, and numerous in-plane defects. In contrast, the smaller counterparts (S-pGO) present a fewer in-plane defects. The performance metrics revealed that L-pGO exhibited a water flux of 849.25 L m-2  h-1  bar-1 , while S-pGO demonstrated nearly 100 % dye rejection capacity. These findings underscore the potential of defect engineering as a powerful strategy to enhance the efficiency of two-dimensional membranes.

Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management

Thyroid eye disease (TED) is a rare disease that can lead to decreased quality of life, permanent disfigurement, and vision loss. Clinically, TED presents with exophthalmos, periorbital edema, extraocular muscle dysfunction, and eyelid retraction, and can lead to vision-threatening complications such as exposure to keratopathy and dysthyroid optic neuropathy (DON). Over the last several years, significant advancements have been made in the understanding of its pathophysiology as well as optimal management. Ethnic variations in the prevalence, clinical presentation, and risk of vision-threatening complications of TED are summarized, and risk factors associated with TED are discussed. Additionally, significant advances have been made in the management of TED. The management of TED traditionally included anti-inflammatory medications, orbital radiation therapy, orbital surgical decompression, and biologic therapies. Most recently, targeted therapies such as teprotumumab, an insulin-like growth factor-1 receptor antagonist, have been studied in the context of TED, with promising initial data. In this review, updates in the understanding and management of TED are presented with a focus on the international variations in presentation and management.

Nontraumatic orbital emergencies: a pictorial essay - CT and MRI features for an imaging findings-based approach

Orbital imaging plays a pivotal role in each hospital with an Ophthalmological Emergency Department. Unenhanced orbital computed tomography (CT) usually represents the first-line tool for the assessment of nontraumatic orbital emergencies, thanks to its quick execution, wide availability, high resolution, and availability of multiplanar reformats/reconstructions. Magnetic resonance imaging (MRI) is an essential tool that allows characterization and a better understanding of the anatomical involvement of different disorders due to its excellent contrast resolution and ability to study the visual pathways, even if, unfortunately, it is not always available in the emergency setting. It represents the first imaging choice in pediatric patients, due to the absence of ionizing radiation. When available, CT and MRI are often used together to diagnose, assess the extent, and provide treatment plans for various orbital nontraumatic emergencies, including infective, inflammatory, vascular, and neoplastic diseases. Familiarity with the imaging appearances of these disorders helps the radiologists to establish the correct diagnosis in the emergency setting, which contributes to timely clinical management. This pictorial essay provides a description of the clinical presentation and imaging findings of nontraumatic orbital emergencies.

Orbital Radiation for Thyroid Eye Disease: A Report by the American Academy of Ophthalmology

PURPOSE

To review the current literature on the safety and efficacy of orbital radiation for the management of thyroid eye disease (TED).

METHODS

A literature search was conducted last in February 2021 of the PubMed database to identify all articles published in the English language on original research that assessed the effect of orbital radiation on TED. The search identified 55 articles, and 18 met the inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study, and all of them were rated level III.

RESULTS

Two large retrospective studies demonstrated the efficacy of radiation treatment, with or without corticosteroid use, in preventing or treating compressive optic neuropathy (CON). Three studies highlighted the role of orbital radiation therapy (RT) to facilitate the tapering of corticosteroids. Several other studies showed a possible role for RT to improve diplopia and soft tissue signs.

CONCLUSIONS

Although no level I or level II evidence exists, the best available evidence suggests that orbital radiation, used with or without corticosteroids, is efficacious in preventing CON, improving motility restriction, and decreasing clinical activity in TED. Orbital radiation also may facilitate a corticosteroid taper. Together, these studies show that RT seems to modify the active phase of TED. Short-term risks of orbital radiation are minor, but long-term outcome data are lacking.

Graves' orbitopathy: a multidisciplinary approach

Orbitopathy is the main extra thyroidal manifestation of Graves' disease. It is a very challenging condition, which requires a cooperation between many specialists (endocrinologists, ophthalmologists, radiologists, radiotherapeutic, orbital surgeons) for an optimal clinical management. An accurate diagnostic assessment is required, in order to plan an adequate treatment of Graves' orbitopathy. Medical therapy, radiotherapy or surgery may be necessary to control the disease. In this review, the authors analyze the various therapeutic strategies, as well the more recent therapies based on pharmacologic immunomodulation.

Updates on the understanding and management of thyroid eye disease

Thyroid eye disease (TED) is a complex disease associated with myriad clinical presentations, including facial disfigurement, vision loss, and decreased quality of life. Traditionally, steroid therapy and/or radiation therapy were commonly used in the treatment of active TED. While these therapies can help reduce inflammation, they often do not have a sustainable, significant long-term effect on disease outcomes, including proptosis and diplopia. Recent advances in our understanding of the pathophysiology of TED have shifted the focus of treatment toward targeted biologic therapies. Biologics have the advantage of precise immune modulation, which can have better safety profiles and greater efficacy compared to traditional approaches. For instance, the insulin-like growth factor-1 receptor (IGF-1R) has been found to be upregulated in TED patients and to colocalize with the thyroid-stimulating hormone receptor (TSHR), forming a signaling complex. Teprotumumab is an antibody targeted against IGF-1R. By inhibiting the IGF-1R/TSHR signaling pathway, teprotumumab may reduce the production of proinflammatory cytokines, hyaluronan secretion, and orbital fibroblast activation in patients with TED. Due to promising phase II and III clinical trial results, teprotumumab has become the first biologic US Food and Drug Administration (FDA)-approved for the treatment of TED. In addition, there are currently ongoing studies looking at the use of antibodies targeting the neonatal Fc receptor (FcRn) in various autoimmune diseases, including TED. FcRn functions to transport immunoglobulin G (IgG) and prevent their lysosomal degradation. By blocking the recycling of IgG, this approach may dampen the body's immune response, in particular the pathogenic IgG implicated in some autoimmune diseases. Advances in our understanding of the pathophysiology of TED, therefore, are leading to more targeted therapeutic options, and we are entering an exciting new phase in the management of TED. This review will cover recent insights into the understanding of TED pathophysiology and novel treatment options as well as ongoing studies of new potential treatment options for TED.