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Liao X, Aljufairi FMAA, Sebastian JU, Jia R, Wong HYM, Lai KKH, Chen W, Hu Z, Wei Y, Chu WCW, Tham CCY, Pang CP, Chong KKL. Investigation of lacrimal gland and extraocular muscle in thyroid eye disease patients with severe subjective dry eye disease: a multiparametric magnetic resonance imaging study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06424-x. [PMID: 38456927 DOI: 10.1007/s00417-024-06424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To analyze the radiological features of the lacrimal gland (LG) and extraocular muscle (EOM) in thyroid eye disease (TED) patients with severe subjective dry eye disease (DED) using magnetic resonance imaging (MRI) measurements. METHODS In this cross-sectional study, mechanical ocular exposure, dry eye assessment and MRI data were collected. Patients were classified into non-severe subjective DED group with ocular surface disease index (OSDI) < 33 and severe subjective DED group with OSDI ≥ 33. Linear regression model was applied for comparing the OSDI < 33 and OSDI ≥ 33 group in TED patients. The predictive performance of MRI parameters and models was assessed by receiver operating characteristic curve (ROC) analysis. RESULTS Consecutive 88 TED patients (176 eyes) were included in this study. In the OSDI < 33 group, 52 TED patients (104 eyes) with a mean clinical activity score (CAS) of 0.63 ± 0.75. In the OSDI ≥ 33 group, there are 36 TED patients (72 eyes), with a mean CAS of 1.50 ± 1.54. The age and sex of the patients were matched between the two groups. The OSDI ≥ 33 group had shorter tear break-up time, larger levator palpebrae superioris / superior rectus (LPS/SR), inferior rectus and lateral rectus, smaller LG, more inflammatory LPS/SR and inferior rectus than OSDI < 33 DED group (P < 0.05). In the linear regression analysis, compare to the OSDI < 33 DED group, the OSDI ≥ 33 group had larger medial rectus cross-sectional area (β = 0.06, 95%CI: (0.02, 0.10), P = 0.008), larger inferior rectus cross-sectional area (β = 0.06, 95%CI: (0.00, 0.12), P = 0.048), smaller LG cross-sectional area (β = -0.14, 95%CI: (-0.25, -0.04), P = 0.008). In the ROC analysis, the area under curve of medial rectus, inferior rectus, LG, and combined model are 0.625, 0.640, 0.661 and 0.716, respectively. CONCLUSION Multiparametric MRI parameters of the LG and EOM in TED patients with severe subjective DED were significantly altered. Novel models combining the cross-sectional area of LG, medial rectus and inferior rectus showed good predictive performance in TED patients with severe subjective DED.
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Affiliation(s)
- Xulin Liao
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama, 435, Bahrain
| | - Jake Uy Sebastian
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Ruofan Jia
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hanson Yiu Man Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Kenneth Ka Hei Lai
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
- Department of Ophthalmology, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Wanxue Chen
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Zhichao Hu
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Yingying Wei
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement Chee Yung Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Kelvin Kam Lung Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China.
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Prinz J, Hartmann K, Migliorini F, Hamesch K, Walter P, Fuest M, Kuerten D. Efficacy of allogenous fascia lata grafts in the management of lower eyelid retraction. Int Ophthalmol 2023; 43:4729-4737. [PMID: 37721702 PMCID: PMC10724318 DOI: 10.1007/s10792-023-02873-1] [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: 04/18/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE To report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER). METHODS In this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0-81.0, median 13.0, last follow-up) months in all patients. RESULTS At the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit. CONCLUSION In this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Kathi Hartmann
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | | | - Karim Hamesch
- Department of Gastroenterology and Hepatology, RWTH Aachen University, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
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Lai EW, Tai YH, Wu HL, Dai YX, Chen TJ, Cherng YG, Lai SC. The Association between Autoimmune Thyroid Disease and Ocular Surface Damage: A Retrospective Population-Based Cohort Study. J Clin Med 2023; 12:jcm12093203. [PMID: 37176642 PMCID: PMC10179488 DOI: 10.3390/jcm12093203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Autoimmune thyroid diseases (ATDs) are potentially connected to lacrimal gland dysfunction and ocular surface disruption. This study aimed to evaluate the relationships between ATD, dry eye disease (DED), and corneal surface damage. In a matched nationwide cohort study, we used Taiwan's National Health Insurance research database to compare the incidences of DED and corneal surface damage between subjects with and without ATD. Multivariable Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the ophthalmological outcomes. A total of 50,251 matched pairs with 748,961 person-years of follow-up were included for analysis. The incidence of DED was 16.37 and 8.36 per 1000 person-years in the ATD and non-ATD groups, respectively. ATDs were significantly associated with increased DED (aHR: 1.81, 95% CI: 1.73-1.89, p < 0.0001). This association was generally consistent across the subgroups of age, sex, different comorbidity levels, and use of systemic corticosteroids or not. Furthermore, patients with ATD had a higher risk of corneal surface damage compared with non-ATD subjects (aHR: 1.31, 95% CI: 1.19-1.44, p < 0.0001), including recurrent corneal erosions (aHR: 2.00, 95% CI: 1.66-2.41, p < 0.0001) and corneal scars (aHR: 1.26, 95% CI: 1.01-1.59, p = 0.0432). Other independent factors for corneal surface damage were age, sex, diabetes mellitus, Charlson Comorbidity Index scores, and use of systemic corticosteroids. Our results suggested that ATDs were associated with higher risks of DED and corneal surface damage. Considering the high prevalence of ATD, prophylactic and therapeutic strategies should be further developed to prevent irreversible vision loss in this susceptible population.
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Affiliation(s)
- Eric W Lai
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ying-Xiu Dai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu 31064, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Chung Lai
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Yilmaz Tuğan B, Özkan B, Yüksel R, Güray AB, Yüksel N. Is Corneal Subbasal Nerve Loss Associated With Meibomian Gland Loss in Inactive Mild and Moderate-to-Severe Graves' Ophthalmopathy? Ophthalmic Plast Reconstr Surg 2023; 39:174-181. [PMID: 36136738 DOI: 10.1097/iop.0000000000002280] [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: 11/25/2022]
Abstract
PURPOSE To evaluate meibomian gland and subbasal nerve plexus parameters in Graves' Ophthalmopathy (GO) and association of meibomian gland loss with corneal subbasal nerve plexus loss. METHODS Fifty-two eyes of 52 mild and moderate-to-severe GO patients and 32 eyes of 32 healthy controls were enrolled. The meibomian gland dropout area (MGDA) and meibography scores were evaluated using noncontact meibography. In vivo confocal microscopy of corneal subbasal nerve plexus were conducted. ACCMetrics was used to obtain corneal parameters. RESULTS Compared with healthy subjects, GO patients had worse upper and lower eyelid MGDA ( p < 0.001, for all) and upper, lower and total meibography scores ( p < 0.001, p = 0.001, and p < 0.001, respectively). Eyelid margin scores were worse in the GO group ( p < 0.001) and showed correlation with all noncontact meibography parameters ( p < 0.001 for all). All corneal subbasal nerve parameters were significantly lower in the GO group compared with the controls ( p < 0.05 for all). Subbasal nerve parameters of GO patients did not reveal a correlation with MGDA and meibography scores but showed correlations with ocular surface disease index score and Schirmer I test (r = -0.304; p = 0.042 and r = 0.336; p = 0.021, respectively). CONCLUSION Meibomian gland and corneal nerve loss could be observed even in the inactive phase and mild GO. The lack of a correlation between meibomian gland loss and subbasal nerve loss suggests that meibomian gland loss is not a significant additional component in the pathogenesis of subbasal nerve damage in GO. Furthermore, our study revealed new evidence regarding the use of eyelid margin score to represent meibomian gland loss in GO.
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Affiliation(s)
| | - Berna Özkan
- Acibadem Mehmet Ali Aydinlar University, Department of Ophthalmology, İstanbul, Turkey
| | - Refref Yüksel
- Şanliurfa Research and Training Hospital, Şanliurfa, Turkey
| | | | - Nurşen Yüksel
- Kocaeli University, Department of Ophthalmology, Kocaeli, Turkey
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Huang X, Tang W, Shen Y, He L, Tong F, Liu S, Li J, Li P, Zhang Y, Ma X, Wei R, Yang W. The significance of ophthalmological features in diagnosis of thyroid-associated ophthalmopathy. Biomed Eng Online 2023; 22:7. [PMID: 36739403 PMCID: PMC9898900 DOI: 10.1186/s12938-023-01073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Thyroid-associated ophthalmopathy (TAO) is an autoimmune disorder. It has discriminable appearance. This study was conducted to dig the clinical significance of demographic characteristics and ophthalmologic diagram features in TAO diagnosis and stage/severity evaluation. RESULTS We included 320 males and 633 females, with an average age of 41.75 ± 13.75. A majority of TAO patients had hyperthyroidism, and most of them were in the inactive stage and at the moderate level. The thyroid function type, stage and severity were closely associated with hypopsia, eyelid congestion, conjunctival congestion, corneal ulcer, ocular motility disorder, best corrected visual acuity, and extraocular muscle thickening. Using these features, we established different logistic regression models to predict thyroid function subtypes, abnormal thyroid function, stage, and severity, in which the AUC of the ROC curve and accuracies were satisfactory. CONCLUSION Together, TAO subtype, stage and severity can be diagnosed by auxiliary references including demographic factors, symptoms from complains, and image features. These non-invasive indices can be applied in a timely manner in clinical estimating TAO status.
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Affiliation(s)
- Xiao Huang
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Wei Tang
- grid.73113.370000 0004 0369 1660Department of Endocrinology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Ya Shen
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Linfeng He
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Fei Tong
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Siyu Liu
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China ,grid.73113.370000 0004 0369 1660Department of Ophthalmology, Naval Medical Center of the PLA, Naval Medical University, Shanghai, 200052 China
| | - Jian Li
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Pan Li
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Yun Zhang
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Xiaoye Ma
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Ruili Wei
- grid.73113.370000 0004 0369 1660Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, 200003 China
| | - Weihua Yang
- grid.89957.3a0000 0000 9255 8984The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, 210004 Jiangsu China
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Acar M, Sabur H, Arslan N. Ocular surface and in vivo confocal microscopic findings in patients with active tyhroid eye disease treated with glucocorticoids. Eur J Ophthalmol 2023; 33:1354-1360. [PMID: 36734075 DOI: 10.1177/11206721231155209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To evaluate the effect of treatment with high-dose glucocorticoids (HDG) on ocular surface parameters and in vivo confocal microscopy (IVCM) findings in patients with active thyroid eye disease (TED). METHODS This study included 15 active TED patients treated with a cumulative HDG dose of 4.5g (500 mg and then 250 mg for 6 weeks each). Disease activity was assessed by the clinical activity score (CAS), Graves' Orbitopathy-specific Quality of Life (GO-QoL) questionnaire, ocular surface disease index (OSDI), tear break-up time(T-BUT), ocular surface staining and IVCM. RESULTS The mean follow-up time was 48.6 months. The treatment resulted in a significant improvement in the T-BUT, ocular surface staining values. In comparison to the baseline, a notable reduction in CAS, OSDI and an increase in GO-QoL were seen after one year. IVCM showed a significant decrease in the number of dendritic cells, activated keratocytes, the degree of tortuosity, there was also a significant increase in the number of basal epithelial cells and total nerves over one-year period. All of those changes remained stable during the follow-up period. CONCLUSION HDG treatment results in a sustained decrease in corneal inflammatory cells, an increase in tear film stability, and an improvement in disease symptoms and QoL scores for up to 4 years.
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Affiliation(s)
- Mutlu Acar
- Department of Ophthalmology, University of Health Sciences, 146992Ankara Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey
| | - Huri Sabur
- Department of Ophthalmology, University of Health Sciences, 146992Ankara Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey
| | - Neşe Arslan
- Department of Ophthalmology, University of Health Sciences, 146992Ankara Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey
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Zhou X, Wei R, Wang R. Characterization of human tear proteome reveals differentially abundance proteins in thyroid-associated ophthalmopathy. PeerJ 2022; 10:e13701. [PMID: 35846879 PMCID: PMC9285480 DOI: 10.7717/peerj.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/17/2022] [Indexed: 01/17/2023] Open
Abstract
Background Thyroid-associated ophthalmopathy (TAO) is a common orbital inflammatory disease, but the abnormal expression of proteins in tears of TAO patients has not been systematically studied. The purpose of this study is to compare and analyze the total tear protein profile of TAO patients and to provide protein cues for TAO pathogenesis. Methods Tear samples were isolated from 30 TAO patients with obvious ocular surface damage and 30 healthy control subjects. Tear samples from 30 individuals were mixed and divided into three sample pools. Easy nano-scale LC-MS/MS based on labeling-free quantitative technology was utilized to profile tear proteome. Results Here, electrospray ionization mass spectra and SDS-PAGE results confirmed the good parallelisms among samples. A total of 313 proteins were obtained from six tear pools, among them, 103 differential abundance proteins (DAPs) were identified, including 99 up-regulated DAPs (including APOA1, HV103, IGH, and Transferrin variant) and four down-regulated DAPs (including FABA, VCC1, NUCB2, and E-cadherin) in the TAO group compared with the control group. GO analysis showed that up-regulated DAPs were mainly enriched in lipid metabolism and platelet molecular function, and down-regulated DAPs were involved in binding, cell junction, and cellular process. KEGG results indicated that DAPs were involved in 117 kinds of signal transduction pathways, among which the immune-related pathway of complement and coagulation cascades had the greatest relevance. Conclusion In conclusion, label-free LC-MS/MS is an effective strategy for profiling tear proteins component. Our study provides proteins and pathways altered in TAO and provides protein cues for further study on the precise mechanism of TAO pathogenesis.
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Affiliation(s)
- Xiaoqing Zhou
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, Shanghai, China
| | - Ruili Wei
- Department of Ophthalmology, Shanghai Changzheng Hospital, Shanghai, Shanghai, China
| | - Rui Wang
- Proteome Research Cente, Shanghai Applied Protein Technology, Shanghai, Shanghai, China
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Hsu CK, Hsieh MW, Chang HC, Chen YH, Chien KH. Improvement of Ocular Surface Disease by Lateral Tarsoconjunctival Flap in Thyroid-Associated Orbitopathy Patients with Lid Retraction. J Pers Med 2022; 12:jpm12050802. [PMID: 35629224 PMCID: PMC9146611 DOI: 10.3390/jpm12050802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023] Open
Abstract
There is a high incidence of ocular surface disease (OSD) in thyroid-associated orbitopathy (TAO) patients as a result of incomplete eyelid closure and chronic inflammatory eyelid status. This study was performed to evaluate the efficacy of a lateral tarsoconjunctival flap (LTF) in improving OSD in TAO patients from the perspective of correcting eyelid closures. As a study design, TAO patients were enrolled in this study to evaluate OSD perioperatively before they were scheduled for LTF surgery. Additional lid surgery was also recorded. The outcome was evaluated with perioperative OSD measurements and tear inflammatory mediators at baseline and one month and three months postoperatively. As a result, 42 patients (5 male, 37 female) underwent LTF surgery, and 13 patients received medial pretarsal support with collagen grafts. Eleven patients underwent blepharotomy, and 6 patients received Botox injections for upper lid retraction. The mean age of the participants was 46.4 years old, and the mean follow-up period was 10.6 months. Their clinical activity score (CAS) at the time of the operation was 2.1. Dry eye parameters, such as ocular surface disease index, tear breakup time, Schirmer’s I test score, and meibomian gland dropout were all significantly improved 3 months postoperatively. Tear osmolarity and inflammatory mediators in tear fluid, such as IL-6, IL-8, IL-18 and MCP-1, were also significantly improved after the procedures. After the surgery, all complications were mild and temporary. As a conclusion, LTF could provide TAO patients with both lid retraction correction and improvement of ocular surface disorders. Dry eye parameters significantly improved 3 months postoperatively. This method can serve as an alternative treatment option for lid correction in TAO patients.
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Affiliation(s)
- Chih-Kang Hsu
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan; (C.-K.H.); (Y.-H.C.)
- Department of Ophthalmology, Tri-Service General Hospital Songshan Branch, Songshan, Taipei 105, Taiwan
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan;
| | - Hsu-Chieh Chang
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan; (C.-K.H.); (Y.-H.C.)
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan; (C.-K.H.); (Y.-H.C.)
- Correspondence: ; Tel.: +88-62-8792-3311
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Gao Y, Chang Q, Li Y, Zhang H, Hou Z, Zhang Z, Li Z, Li D. Correlation between extent of lacrimal gland prolapse and clinical features of thyroid-associated ophthalmopathy: a retrospective observational study. BMC Ophthalmol 2022; 22:66. [PMID: 35144579 PMCID: PMC8832675 DOI: 10.1186/s12886-022-02270-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Studies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited. This study aimed to assess the factors associated with LGP on magnetic resonance imaging (MRI) and its relation to TAO activity . Methods Thirty-six patients (72 orbits) with inactive TAO (43 orbits, Clinical Activity Score [CAS] < 3) or active TAO (29 orbits, CAS ≥3) were investigated retrospectively. All patients underwent ophthalmic evaluation and orbital magnetic resonance imaging. The severity of LGP and proptosis and the extraocular muscle (EOM) volume were measured. LGP and related factors were assessed by correlational and linear regression analyses. The value of LGP for discriminating the activity of TAO was evaluated by receiver-operating characteristic curve analysis. Results The mean LGP was significantly higher in the active TAO group than in the inactive TAO group (P < 0.001). There were significant positive correlations between LGP severity and the CAS (r = 0.51, P < 0.001), proptosis (r = 0.72, P < 0.001), and EOM volume (superior rectus [r = 0.49, P < 0.001], inferior rectus [r = 0.47, P < 0.001], lateral rectus [r = 0.59, P < 0.001], medial rectus [r = 0.62, P < 0.001], superior oblique [r = 0.48, P < 0.001], and all EOMs [r = 0.59, P < 0.001]). Receiver-operating characteristic curve analysis revealed an LGP of 13.65 mm (area under the curve, 0.824; sensitivity, 79.3%; specificity, 81.4%) to be the cut-off value that differentiated active and inactive TAO. Conclusions LGP measurements obtained from orbital magnetic resonance images were positively correlated with CAS, proptosis and EOM volume. The extent of LGP appears to be a good indicator of disease activity in patients with TAO.
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Affiliation(s)
- Yang Gao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qinglin Chang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hanqiao Zhang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhijia Hou
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Zhang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dongmei Li
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Ophthalmology & Visual Sciences Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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10
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Ocular surface disease in thyroid eye disease: A narrative review. Ocul Surf 2022; 24:67-73. [PMID: 35167950 PMCID: PMC9058200 DOI: 10.1016/j.jtos.2022.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 01/03/2023]
Abstract
Ocular surface disease (OSD) in the setting of thyroid eye disease (TED) is traditionally thought of as a natural consequence of anatomical changes such as proptosis and corneal exposure. However, a growing body of research suggests that ocular surface inflammation and multi-factorial changes to the homeostasis of the ocular surface contribute substantially to the OSD seen in TED patients. In this paper we review the existing literature which highlights the work and existing theories underlying this new paradigm shift.
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11
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Levine H, Hwang J, Dermer H, Mehra D, Feuer W, Galor A. Relationships between activated dendritic cells and dry eye symptoms and signs. Ocul Surf 2021; 21:186-192. [PMID: 34102312 PMCID: PMC8328957 DOI: 10.1016/j.jtos.2021.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine whether "activated" dendritic cells (aDCs) could serve as a biomarker of systemic immune disorders in individuals with dry eye (DE) symptoms. Secondarily, to examine the impact of a topical anti-inflammatory agent on aDC number. METHODS Retrospective analysis was conducted to identify individuals with DE symptoms who had in-vivo confocal microscopy (IVCM) imaging between October 2018 and July 2020 at the Miami Veterans Hospital. aDCs were manually quantified based on morphology. Receiver operating curve (ROC) analysis examined relationships between aDC number and systemic immune disease status. Individuals were then grouped by aDC number (≥2 versus <2) and demographics and DE parameters were examined. Paired t-test was performed to evaluated aDC number pre-vs post-initiation of an anti-inflammatory agent. RESULTS 128 individuals were included. Their mean age was 57.1 ± 15.0 years; 71.1% were male, 53.1% self-identified as White and 24.2% as Hispanic. The mean number of aDCs in the central cornea was 1.28 ± 2.16 cells/image. The presence of ≥2 aDCs had a sensitivity of 60% and specificity of 77% for the diagnosis of a systemic immune disorder. Individuals with ≥2 aDCs were more likely to self-identify as Black, have Secondary Sjögren's, and have higher nerve fiber area and fractal dimension. In 12 individuals, aDC number decreased from 2.69 ± 2.36 to 0.58 ± 0.73 cells/image after initiation of an anti-inflammatory agent, p = 0.01. CONCLUSIONS The presence of ≥2 aDCs in the central cornea suggests a systemic immune disorder in individuals with DE symptoms. Topical anti-inflammatory therapy can reduce the number of aDCs in the central cornea.
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Affiliation(s)
- Harry Levine
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jodi Hwang
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harrison Dermer
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Divy Mehra
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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12
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Cheng S, Yu Y, Chen J, Ye L, Wang X, Jiang F. In vivo confocal microscopy assessment of meibomian glands microstructure in patients with Graves' orbitopathy. BMC Ophthalmol 2021; 21:261. [PMID: 34147078 PMCID: PMC8214770 DOI: 10.1186/s12886-021-02024-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 06/09/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate microstructural changes in the meibomian glands (MGs) in patients with active and inactive Graves' orbitopathy (GO), using in vivo confocal microscopy (IVCM), and to investigate the correlations between clinical and confocal findings. METHODS Forty patients (80 eyes) with GO (34 eyes with active GO, 46 eyes with inactive GO), and 31 age- and sex-matched control participants (62 eyes) were enrolled consecutively. A researcher recorded the clinical activity score (CAS) for each patient. A complete ophthalmic examination was then performed, including external eye, ocular surface and MGs. IVCM of the MGs was performed to determine the MG acinar density (MAD), MG longest and shortest diameters (MALD and MASD), MG orifice area (MOA), MG acinar irregularity (MAI), meibum secretion reflectivity (MSR), acinar wall inhomogeneity (AWI), acinar periglandular interstices inhomogeneity (API), and severity of MG fibrosis (MF). RESULTS All confocal microscopy assessments of MGs significantly differed among groups (all P = 0.000). Compared to controls, GO groups showed lower MOA (1985.82 ± 1325.30 μm2 in active GO and 2021.59 ± 1367.45 μm2 in inactive GO vs. 3896.63 ± 891.90 μm2 in controls, all P = 0.000) and MAD (87.21 ± 32.69 /mm2 in active GO and 80.72 ± 35.54 /mm2 in inactive GO vs. 114.69 ± 34.90 /mm2 in controls, P = 0.001 and 0.000, respectively); greater MALD (118.11 ± 30.23 μm in active GO and 120.58 ± 27.64 μm in inactive GO vs. 58.68 ± 20.28 μm in controls, all P = 0.000) and MASD (44.77 ± 19.16 μm in active GO and 46.02 ± 20.70 μm in inactive GO vs. 27.80 ± 9.90 μm in controls, all P = 0.000); and higher degrees of MAI, MSR, and MF (all P<0.05). Eyes with active GO had higher degrees of MAI (P = 0.015), AWI (P = 0.000), and API (P = 0.000), while eyes with inactive GO had higher degrees of MSR (P = 0.000) and MF (P = 0.017). In GO groups, AWI and API were positively correlated with CAS (r = 0.640, P = 0.000; r = 0.683, P = 0.000, respectively), and MF was negatively correlated with CAS (r = - 0.228, P = 0.042). CONCLUSIONS IVCM effectively revealed microstructural changes of MGs in eyes with GO and provided strong in vivo evidence for the roles of obstruction and inflammation in the ocular surface disease process. Furthermore, it revealed discernible patterns of MG abnormalities in eyes with active GO and inactive GO, which are not easily distinguishable by typical clinical examinations.
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Affiliation(s)
- Shengnan Cheng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yueqi Yu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jin Chen
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lin Ye
- Department of General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Fagang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Allam IY, Lazreg S, Shafik Shaheen M, Doheim MF, Mohammed MA. Ocular Surface Changes in Patients with Thyroid Eye Disease: An Observational Clinical Study. Clin Ophthalmol 2021; 15:2481-2488. [PMID: 34163131 PMCID: PMC8214558 DOI: 10.2147/opth.s317708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to compare ocular surface parameter changes in active and inactive thyroid eye disease (TED) patients and controls. Methods This is an observational clinical study that included 60 eyes divided into three groups following clinical activity score (CAS) assessment. The first group (Group A) comprised 20 eyes with active TED (CAS score ≥3/7), while the second group (Group B) comprised 20 eyes with inactive TED (CAS score <3/7) and the third group (Group C) comprised 20 eyes of controls without dry eye manifestations. The palpebral fissure height, degree of proptosis, degree of lagophthalmos, ocular surface disease index (OSDI), Schirmer test without anesthesia, corneal fluorescein staining (CFS), non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), lipid layer thickness (LLT), meiboscore, meibomian gland dysfunction (MGD), and thyroid antibodies were assessed and data were compared between study participants. Results The mean OSDI was 40.0 ±5.80 in Group A, which significantly differed from Group B with a mean of 26.5 ±5.10 (p=0.02). There were significant differences between the two groups regarding palpebral fissure height (p=0.02), amount of proptosis (p=0.008), and degree of lagophthalmos (p=0.001). Similarly, active TED patients had more decreased tear secretion than inactive TED patients (p=0.012). Moreover, active TED patients showed a significant increase in Meibomian gland loss areas in both upper and lower eyelids compared with inactive TED patients (p=0.001). Corneal fluorescein staining also revealed a statistically significant difference between the studied groups (p=0.0001). Conclusion This study showed differences regarding ocular surface parameter changes between both active and inactive TED and compared to controls. Further studies are needed to confirm these results.
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Affiliation(s)
- Ibrahim Y Allam
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sihem Lazreg
- Cabinet Ophtalmologie, Alger Centre, Algiers, Algeria
| | | | - Mohamed Fahmy Doheim
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mai A Mohammed
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Baratta RO, Schlumpf E, Buono BJD, DeLorey S, Calkins DJ. Corneal collagen as a potential therapeutic target in dry eye disease. Surv Ophthalmol 2021; 67:60-67. [PMID: 33882269 DOI: 10.1016/j.survophthal.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 01/15/2023]
Abstract
Dry eye disease (DED) is a major cause of ocular discomfort, inflammation and dysfunction worldwide. Tear film instability in DED both causes and is exacerbated by disruption of the corneal epithelium. This tandem leads to a cycle of inflammation at the corneal surface involving immune cell dysregulation and increased chemokines and cytokines, which activate mitogen-activated protein kinases in the epithelium and elevates matrix metalloproteinases (MMPs). We review evidence suggesting that corneal collagen might be highly susceptible in DED to MMP-induced disruption, digestion, and thinning. We also summarize that collagen is far from inert and contains binding sites that serve as ligands for multiple inflammatory and immune regulators. Fragmented collagen not only challenges these receptor-ligand binding relationships, but also can promote recruitment and motility of pro-inflammatory immune cells. Current physician-directed therapies for DED focus on reducing inflammation, but do not directly ameliorate the underlying corneal damage that could exacerbate surface inflammation. We argue that an important gap in practice is lack of a direct therapeutic reparative for damaged corneal collagen, which is slow to heal, and likely amplifies sight-threatening inflammation. Healing fragmented collagen in the cornea may represent a more effective means to interrupt the "vicious cycle" of inflammation in DED and other conditions that damages, sometimes irreversibly, the ocular surface.
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Affiliation(s)
- Robert O Baratta
- Stuart Therapeutics, Inc., 411 SE Osceola St., Suite 203, Stuart, FL 34994
| | - Eric Schlumpf
- Stuart Therapeutics, Inc., 411 SE Osceola St., Suite 203, Stuart, FL 34994
| | - Brian J Del Buono
- Stuart Therapeutics, Inc., 411 SE Osceola St., Suite 203, Stuart, FL 34994
| | - Shawn DeLorey
- Stuart Therapeutics, Inc., 411 SE Osceola St., Suite 203, Stuart, FL 34994
| | - David J Calkins
- The Vanderbilt Eye Institute and Vanderbilt Vision Research Center, AA7100 MCN, 1161 21st Ave S. Nashville, TN 37232-2279.
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15
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Zhang T, Li M, Xiao W, Ye H, Chen R, Yuan J, Yang H. Bulbar Conjunctival Microvascular Alterations in Thyroid-Associated Ophthalmopathy Patients with Different Activities. Curr Eye Res 2021; 46:943-948. [PMID: 33719776 DOI: 10.1080/02713683.2020.1849729] [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: 12/19/2022]
Abstract
Purpose: To evaluate the morphologic and hemodynamic changes of bulbar conjunctival vessels in thyroid-associated ophthalmopathy (TAO) patients and the correlations with the activity.Methods: Patients diagnosed as TAO with different clinical activity scores (CAS) and healthy participants were recruited. All subjects underwent a complete ophthalmic examination and functional slit-lamp biomicroscope. Vascular variables including the vessel density, vessel complexity, average diameter, blood flow velocity and blood flow rate in microvascular networks were measured. The correlations among microvascular parameters, CAS and exophthalmos were analyzed. Areas under the receiver operating characteristic curves (AUROCs) were applied to evaluate the diagnostic accuracy of microvascular alterations for active TAO.Results: A total of 46 eyes were enrolled in our study. The vessel complexity and blood flow velocity increased in the active TAO group significantly compared with the inactive group and healthy controls (P < .05). Meanwhile, the vessel complexity and blood flow rate were positively correlated with CAS (r = 0.641 and r = 0.526). Bulbar conjunctival microvascular parameters performed a good ability in distinguishing the active stage of TAO (AUROC = 0.793).Conclusions: Increasing bulbar conjunctival vessel complexity and blood flow were evident in TAO with severe inflammation. The measurements of bulbar conjunctival microvasculature could be a reference to evaluate activity in TAO.
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Affiliation(s)
- Te Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Meng Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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16
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Altin Ekin M, Karadeniz Ugurlu S, Egrilmez ED, Oruk GG. Ocular Surface Changes in Hashimoto's Thyroiditis Without Thyroid Ophthalmopathy. Eye Contact Lens 2021; 47:32-37. [PMID: 32097187 DOI: 10.1097/icl.0000000000000686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to evaluate ocular surface changes in patients with Hashimoto's thyroiditis without thyroid ophthalmopathy and elucidate the relationship between dry eye syndrome and meibomian gland dysfunction (MGD) in cases of Hashimoto's thyroiditis. METHODS This prospective study included 105 patients with Hashimoto's thyroiditis and 105 age- and sex-matched controls. The 12-item Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. Both eyes affected by Hashimoto's thyroiditis and normal eyes were evaluated and compared with regard to the following parameters: Hertel exophthalmometry, palpebral fissure height, tear-film breakup time (TBUT), Schirmer 1 test, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores, and areas of meibomian gland loss. RESULTS The eyes affected by Hashimoto's thyroiditis demonstrated significantly lower TBUTs (P<0.001), Schirmer 1 test scores (P<0.001), and meibomian gland expression (P<0.05) and significantly higher OSDI scores (P<0.001), corneal fluorescein staining results (P<0.05), eyelid abnormality scores (P<0.05), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05). Ocular Surface Disease Index scores were significantly positively correlated with eyelid abnormality scores (P=0.025), meibography scores (P<0.05), and areas of meibomian gland loss (P<0.05) and negatively correlated with meibomian gland expression (P<0.05). The duration of Hashimoto's thyroiditis was significantly positively correlated with MGD (P<0.05). CONCLUSION Dry eye syndrome and ocular discomfort symptoms are significantly more common among patients with Hashimoto's thyroiditis, even in the absence of thyroid ophthalmopathy. Dry eye syndrome in patients with Hashimoto's thyroiditis is believed to result from MGD and is correlated with the duration of the thyroid disease.
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Affiliation(s)
- Meryem Altin Ekin
- Department of Ophthalmology (M.A.E., S.K.U., E.D.E.), Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey ; and Department of Endocrinology and Metabolism (G.G.O.), Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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17
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Murthy SI, Das S, Deshpande P, Kaushik S, Dave TV, Agashe P, Goel N, Soni A. Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic - A perspective. Indian J Ophthalmol 2020; 68:1371-1379. [PMID: 32587167 PMCID: PMC7574141 DOI: 10.4103/ijo.ijo_1267_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ocular pain is a common complaint which forces the patient to seek immediate medical attention. It is the primeval first response of the body to any severe condition of the eye such as trauma, infections and inflammation. The pain can be due to conditions directly affecting the eye and ocular adnexa; or indirect which would manifest as referred pain from other organ structures such as the central nervous system. Paradoxically, there are several minor and non-sight threatening conditions, which also leads to ocular pain and does not merit urgent hospital visits. In this perspective, we intend to provide guidelines to the practising ophthalmologist for teleconsultation when a patient complains of pain with focus on how to differentiate the various diagnoses that can be managed over teleconsultation and those requiring emergency care in the clinic. These guidelines can decrease unnecessary hospital visits, which is the need of the hour in the pandemic era and also beyond. Patients who are under quarantine and those who are unable to travel would be benefitted, and at the same time, the burden of increased patient load in busy hospital systems can be reduced.
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Affiliation(s)
- Somasheila I Murthy
- Department of Cornea, The Cornea Institute, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Sujata Das
- Department of Cornea and Anterior Segment, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | | | - Sushmita Kaushik
- Department of Glaucoma, Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarjani Vivek Dave
- Department of Ophthalmic Plastic Surgery, L.V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India
| | - Prachi Agashe
- Department of Pediatric Ophthalmology, Strabismus and Neurophthalmology K.B. Haji Bachooali Eye Hospital and Agashe Hospital, Mumbai, Maharashtra, India
| | - Nupur Goel
- Crystal Clear Eye Institute and Apex, Mumbai, Maharashtra, India
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18
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Xu N, Cui Y, Fu D, Sun F. Tear inflammatory cytokines and ocular surface changes in patients with active thyroid eye disease treated with high-dose intravenous glucocorticoids. J Endocrinol Invest 2020; 43:901-910. [PMID: 31927748 DOI: 10.1007/s40618-019-01174-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/22/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate high-dose intravenous glucocorticoid treatment on tear inflammatory cytokines and ocular surface parameters in patients with active TED. Correlations between tear inflammatory cytokines and clinical parameters were also investigated. METHODS This prospective pilot study included 15 moderate-to-severe and active TED patients. Control group consist of 15 sex and age-matched healthy subjects. All TED patients were treated with high-dose intravenous methylprednisolone with cumulative dose of 4.5 g during the therapy subdivided into 12 weekly infusions. Tear concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) were measured by multiplex bead analysis in TED patients at baseline and 12 weeks after treatment. Ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescent staining, and Schirmer's test were obtained from TED and controls. RESULTS All baseline cytokine levels except for IL-17A were significantly elevated in active TED patients compared with controls. Concentrations of IL-1β, IL-6, IL-8, TNF-α, and VEGF were significantly decreased at 12 weeks compared with baseline. OSDI and TBUT showed significant improvement at 6 and 12 weeks. There were significant positive correlations between IL-6, IL-8, and CAS, and negative correlation was found between IL-6 level and TED duration before methylprednisolone treatment. The reduction of IL-6, IL-8, and VEGF were positive correlated with the reduction in CAS at 12 weeks. CONCLUSIONS High-dose glucocorticoids treatment improved ocular surface symptom, increased the tear film stability, and decreased tear inflammatory cytokines in active TED. The reduction of the inflammatory cytokines is consistent with the improvement of clinical parameters.
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Affiliation(s)
- N Xu
- Department of Oculoplastic and Orbital Diseases, Tianjin Medical University Eye Hospital, No. 251, Fukang Road, Nankai District, Tianjin, 300384, China
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China
- Department of Ophthalmology and Optometry, Fujian Medical University, Fuzhou, China
| | - Y Cui
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Ophthalmology and Optometry, Fujian Medical University, Fuzhou, China
| | - D Fu
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Ophthalmology and Optometry, Fujian Medical University, Fuzhou, China
| | - F Sun
- Department of Oculoplastic and Orbital Diseases, Tianjin Medical University Eye Hospital, No. 251, Fukang Road, Nankai District, Tianjin, 300384, China.
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Park J, Baek S. Dry eye syndrome in thyroid eye disease patients: The role of increased incomplete blinking and Meibomian gland loss. Acta Ophthalmol 2019; 97:e800-e806. [PMID: 30593716 DOI: 10.1111/aos.14000] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/16/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare the structure and function of the Meibomian gland and eyelid blinking patterns between thyroid eye disease (TED) patients with dry eye and nonthyroidal dry eye (DE) patients. METHODS This was a prospective, cross-sectional and observational study. Clinical measurements were performed as follows: (1) external examination, (2) Lipiview® Interferometer (lipid layer thickness, incomplete blinking rate and meibography) and (3) slit-lamp biomicroscopy (corneal staining, tear break-up time (TBUT), meibum expression). RESULTS The TED and DE groups included 98 and 62 patients, respectively. The meiboscores of the upper eyelid in TED and DE groups were significantly different (1.21 ± 0.76 and 0.94 ± 0.71, respectively, p = 0.046). The rate of incomplete blinking was 53.3 ± 34.5 and 34.6 ± 36.3%, respectively, and was significantly higher in the TED group (p = 0.006). In the TED group, CAS was the only variable affecting the meiboscore of the upper and lower eyelids (p = 0.031, 0.039, respectively). Significantly, active TED patients had more decreased basal tear secretion than inactive TED patients (7.4 ± 2.1 mm versus 8.5 ± 1.5 mm, p = 0.024). Moreover, active TED patients had decreased meibum expression in both upper and lower eyelids compared with inactive TED patients (2.20 ± 0.88 versus 1.08 ± 0.84, p = 0.002 in upper eyelid, 2.10 ± 0.88 versus 1.18 ± 0.88, p = 0.007 in lower eyelid, respectively). CONCLUSION In TED patients, incomplete blinking and loss of Meibomian gland structure in the upper eyelid were more prominent than in DE patients. CAS was a factor affecting the structural loss of Meibomian glands in TED individuals.
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Affiliation(s)
- Jinhwan Park
- Department of Ophthalmology Korea University College of Medicine Seoul Korea
| | - Sehyun Baek
- Department of Ophthalmology Korea University College of Medicine Seoul Korea
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Alanazi SA, Alomran AA, Abusharha A, Fagehi R, Al-Johani NJ, El-Hiti GA, Masmali AM. An assessment of the ocular tear film in patients with thyroid disorders. Clin Ophthalmol 2019; 13:1019-1026. [PMID: 31388294 PMCID: PMC6607206 DOI: 10.2147/opth.s210044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/08/2019] [Indexed: 01/21/2023] Open
Abstract
Objective: To investigate the ocular tear film in patients with thyroid disorders using various tests. Methods: The study involved the assessment of the ocular tear film in 20 patients with thyroid disorders (6 men and 14 women) aged 18-43 years (mean±standard deviation=34.3±3.2 years). An age-matched control group consisting of 20 subjects (8 males and 12 females) ranging in age from 18 to 43 years (31.3±2.9 years) was also examined under similar conditions. All patients completed the Ocular Surface Disease Index questionnaire, followed by the tear ferning test within the right eye. A phenol red thread test was carried out 10 mins later followed by the fluorescein tear break-up test with a 10-min gap between the tests being implemented. Results: The median score for the Ocular Surface Disease Index (P<0.05) showed the condition of mild dry eyes [median (IQR)=15.5 (21.9)] in patients with thyroid disorders compared to the control group [5.6 (3.6)]. The mean score for the phenol red thread test within both the right and left eyes showed acceptable tear volumes of 11.7±8.1 and 10.5±7.4 mm, respectively, but this was much lower (P<0.05) compared to those recorded within the control group (22.2±6.5 and 20.7±5.2 mm, respectively). In addition, the mean for the tear break-up time (P<0.05) scores in both eyes within the patients with thyroid disorders revealed a certain degree of eye dryness (4.9±1.6 and 4.2±1.9 s), while the control group showed normal eye scores (13.2±2.6 and 12.3±2.2 s). The median score for tear ferning grades showed eye dryness [2.0 (2.2)] within the study group and normal eyes [1.2 (0.9)] within the control group. Conclusions: Patients with thyroid disorders have a significant level of eye dryness compared to normal eye subjects.
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Affiliation(s)
- Saud A Alanazi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abdullah A Alomran
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Ali Abusharha
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Raied Fagehi
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Naji J Al-Johani
- Comprehensive Cancer Center, Department of Endocrinology and Thyroid Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gamal A El-Hiti
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Ali M Masmali
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Abusharaha A, Alturki AA, Alanazi SA, Fagehi R, Al-Johani N, El-Hiti GA, Masmali AM. Assessment of tear-evaporation rate in thyroid-gland patients. Clin Ophthalmol 2019; 13:131-135. [PMID: 30662256 PMCID: PMC6327900 DOI: 10.2147/opth.s188614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the tear-evaporation rate in thyroid-gland patients using a VapoMeter. Methods Twenty thyroid gland patients aged 18-43 years (mean 34.3±6.3 years) completed the study. Additionally, an age-matched control group of 20 patients aged 18-43 years (32.2±5.1 years) was enrolled in the study for comparison purposes. An Ocular Surface Disease Index dry-eye questionnaire was completed, followed by a test to determine the tear-evaporation rate using the VapoMeter. The test was performed three times per subject by the same examiner. Two readings were obtained each time. Results Significant differences (P<0.05) were found between mean Ocular Surface Disease Index and tear-evaporation-rate scores within the study and control groups. The average tear-evaporation rate was much higher in the study group (median 41.2 [IQR 41.4] g/m2⋅h) than the control group (15.7 [13.7] g/m2⋅h). Moreover, the average Ocular Surface Disease Index score for thyroid-gland patients was much higher (15.6 [23.4]) compared to the control group (5.5 [7.50]). Conclusion The tear-evaporation rate in thyroid-gland patients was found to be much higher than normal-eye subjects.
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Affiliation(s)
- Ali Abusharaha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Abdulaziz A Alturki
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Saud A Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Naji Al-Johani
- Department of Endocrinology and Thyroid Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11433, Saudi Arabia
| | - Gamal A El-Hiti
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Ali M Masmali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
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Kashkouli MB, Alemzadeh SA, Aghaei H, Pakdel F, Abdolalizadeh P, Ghazizadeh M, Moradpasandi F. Subjective versus objective dry eye disease in patients with moderate-severe thyroid eye disease. Ocul Surf 2018; 16:458-462. [DOI: 10.1016/j.jtos.2018.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
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Bruscolini A, Sacchetti M, La Cava M, Nebbioso M, Iannitelli A, Quartini A, Lambiase A, Ralli M, de Virgilio A, Greco A. Quality of life and neuropsychiatric disorders in patients with Graves' Orbitopathy: Current concepts. Autoimmun Rev 2018; 17:639-643. [DOI: 10.1016/j.autrev.2017.12.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 12/29/2017] [Indexed: 01/17/2023]
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Wang CY, Ho RW, Fang PC, Yu HJ, Chien CC, Hsiao CC, Kuo MT. The function and morphology of Meibomian glands in patients with thyroid eye disease: a preliminary study. BMC Ophthalmol 2018; 18:90. [PMID: 29649988 PMCID: PMC5898047 DOI: 10.1186/s12886-018-0763-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate function and morphology of the meibomian gland (MG) in patients with thyroid eye disease (TED). METHODS In this prospective case series study, patients with unilateral or bilateral TED were consecutively enrolled. The diagnosis of TED was based on the typical orbital findings and/or radiographic evidence. The disease activity of TED was classified according to the clinical activity score (CAS). Degrees of lagophthalmos and exophthalmos, blinking rates, and results of the Schirmer test 1 were also recorded. All patients completed the SPEED questionnaire and underwent MG assessment, including lipid layer thickness (LLT), MG dropout (MGd), and MG expression. RESULTS In total 31 eyes from 17 patients with unilateral or bilateral TED were included. Patients were divided into inactive TED (CAS 0-1; 20 eyes from 11 patients) and active TED (CAS 2-3, 11 eyes from 6 patients) groups. MGd was significantly more severe in the active TED than the inactive TED group [Median (Inter-quartile region): 3.0 (2.0-3.0) vs. 2.0 (1.0-2.0) degree, P = 0.04]. However, patients with active TED had thicker LLT than those with inactive TED (90.0 [80.0-100.0] vs. 65.0 [47.8-82.5] nm, P = 0.02), and LLT was positively correlated with lagophthalmos (r = 0.37, P = 0.04). CONCLUSIONS Patients with active TED had more severe MGd, but thicker LLT. Active TED may cause periglandular inflammation of MGs, leading to MGd, but compensatory secretion from residual MGs and lagophthalmos-induced forceful blinking might temporarily release more lipids over the tear film.
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Affiliation(s)
- Chia-Yu Wang
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Chih Chien
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Chun Hsiao
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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The levels of 12 cytokines and growth factors in tears: hyperthyreosis vs euthyreosis. Graefes Arch Clin Exp Ophthalmol 2018; 256:845-852. [PMID: 29332250 DOI: 10.1007/s00417-017-3892-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Simultaneous analyses of the contents and ratios of 12 cytokines and growth factors in single samples of human tears were performed, and the results were compared between a group of healthy subjects and a group of patients with Graves' hyperthyreosis (GH) without thyroid-associated orbitopathy (TAO). METHODS Determinations and concentration measurements of interleukins (IL-2, IL4, IL-6, IL-8, IL-10, IL-1α, and IL-1β) interferon (IFN-γ), tumor necrosis factor (TNF-α), monocyte chemoattractant protein (MCP-1), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF) were performed with single tear samples from 21 patients with hyperthyreosis and 22 healthy subjects. The analyses were performed using a Randox microchip with an Evidence Biochip Array Analyzer. RESULTS We found significant differences between the healthy donor group and the hyperthyreosis group in the levels of IL-6, IL-10, VEGF, IL-1α, and MCP-1. The concentration of IL-6 was considerably higher in the hyperthyreosis group, IL-10 was higher in the healthy donor group, and VEGF and MPC-1 were higher in the hyperthyreosis group. The IL-8 and IFN-γ levels were higher in the hyperthyreosis group. The ratios of all of the cytokines to anti-inflammatory IL-10 were significantly elevated in the hyperthyreosis group. CONCLUSION There are clear differences in the levels of cytokines and growth factors in the tears of healthy subjects and patients with GH without TAO. Tear cytokine changes and related dysfunctional tear syndrome (DTS) could be an early sign of occult TAO in Graves' hyperthyreosis patients.
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Zhang X, M VJ, Qu Y, He X, Ou S, Bu J, Jia C, Wang J, Wu H, Liu Z, Li W. Dry Eye Management: Targeting the Ocular Surface Microenvironment. Int J Mol Sci 2017; 18:E1398. [PMID: 28661456 PMCID: PMC5535891 DOI: 10.3390/ijms18071398] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 12/24/2022] Open
Abstract
Dry eye can damage the ocular surface and result in mild corneal epithelial defect to blinding corneal pannus formation and squamous metaplasia. Significant progress in the treatment of dry eye has been made in the last two decades; progressing from lubricating and hydrating the ocular surface with artificial tear to stimulating tear secretion; anti-inflammation and immune regulation. With the increase in knowledge regarding the pathophysiology of dry eye, we propose in this review the concept of ocular surface microenvironment. Various components of the microenvironment contribute to the homeostasis of ocular surface. Compromise in one or more components can result in homeostasis disruption of ocular surface leading to dry eye disease. Complete evaluation of the microenvironment component changes in dry eye patients will not only lead to appropriate diagnosis, but also guide in timely and effective clinical management. Successful treatment of dry eye should be aimed to restore the homeostasis of the ocular surface microenvironment.
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Affiliation(s)
- Xiaobo Zhang
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Xiamen University affiliated Xiamen Eye Center, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Vimalin Jeyalatha M
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Yangluowa Qu
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Xin He
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Shangkun Ou
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Jinghua Bu
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Changkai Jia
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Junqi Wang
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Han Wu
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Zuguo Liu
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Xiamen University affiliated Xiamen Eye Center, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
| | - Wei Li
- Eye Institute of Xiamen University, Xiamen 361102, China.
- Medical College of Xiamen University, Xiamen 361102, China.
- Xiamen University affiliated Xiamen Eye Center, Xiamen 361102, China.
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China.
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Tirakunwichcha S, Lerdchanapornchai V, Reinprayoon U, Saonanon P, Snabboon T. Prevalence of dry eye disease in autoimmune thyroid disease and the association of dry eye with clinical signs of thyroid associated ophthalmopathy: observational, noncomparative, cross-sectional study. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.1002.474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Autoimmune thyroid disease (AITD) is a risk factor for dry eye disease. The prevalence of dry eye in AITD is not definitely known.
Objectives
To determine the prevalence of dry eye in AITD and its association with clinical signs of thyroid associated ophthalmopathy (TAO).
Methods
We enrolled a cross-section of 92 patients with AITD between May 1 and August 31, 2013. All were examined to establish thyroid eye signs, and severity was classified as none, mild, and moderate-severe according to the European Group on Graves’ orbitopathy. Dry eye disease was verified using an Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), Schirmer test, and ocular surface fluorescein staining. Features of meibomian glands were inspected. This observational study was registered at www.clinicaltrials.in.th, No. TCTR20130713001.
Results
The prevalence of dry eye in AITD was 27% by OSDI questionnaire (95% confidence interval (CI), 16%-34%); 96% (95% CI, 93%-99%) by TBUT; 69% (95% CI, 62%-75%) by ocular surface staining; and 18% (95% CI, 12%-23%) using a Schirmer test, which associated dry eye and proptosis with an odds ratio (OR) of 9.3 (95% CI, 1.2-70.6, P = 0.031), and lagophthalmos by ocular surface staining with an OR of 5.8 (95% CI, 1.2-27.7, P = 0.026). Dry eye in patients with or without clinical signs of TAO was not significantly different.
Conclusions
The prevalence of dry eye varied by criteria, but was not different in AITD patients with or without TAO. Proptosis and lagophthalmos were associated more strongly with dry eye disease in AITD with TAO, than without.
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Affiliation(s)
- Suppapong Tirakunwichcha
- Department of Ophthalmology , Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Thai Red Cross Society , Bangkok 10330 , Thailand
| | - Vipavee Lerdchanapornchai
- Department of Ophthalmology , Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Thai Red Cross Society , Bangkok 10330 , Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology , Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Thai Red Cross Society , Bangkok 10330 , Thailand
| | - Preamjit Saonanon
- Department of Ophthalmology , Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Thai Red Cross Society , Bangkok 10330 , Thailand
| | - Thiti Snabboon
- Department of Medicine , Faculty of Medicine , Chulalongkorn University and King Chulalongkorn Memorial Hospital , Thai Red Cross Society , Bangkok 10330 , Thailand
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Bunya VY, Bhosai SJ, Heidenreich AM, Kitagawa K, Larkin GB, Lietman TM, Gaynor BD, Akpek EK, Massaro-Giordano M, Srinivasan M, Porco TC, Whitcher JP, Shiboski SC, Criswell LA, Shiboski CH. Association of Dry Eye Tests With Extraocular Signs Among 3514 Participants in the Sjögren's Syndrome International Registry. Am J Ophthalmol 2016; 172:87-93. [PMID: 27644591 DOI: 10.1016/j.ajo.2016.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To identify a screening strategy for dry eye patients with a high likelihood of having Sjogren syndrome (SS) through the evaluation of the association of ocular surface tests with the extraocular signs used for the diagnosis of SS. DESIGN Multicenter cross-sectional study. METHODS The Sjogren's International Clinical Collaborative Alliance (SICCA) registry enrolled 3514 participants with SS or possible SS from 9 international academic sites. Ocular surface evaluation included Schirmer I testing, tear breakup time (TBUT), and staining of the cornea (0-6 points) and conjunctiva (0-6 points). Multivariate logistic regression analysis was performed to identify predictive factors for (1) histopathologic changes on labial salivary gland (LSG) biopsies (positive = focus score of ≥1 focus/4 mm2) and (2) positive anti-SSA/B serology. RESULTS The adjusted odds of having a positive LSG biopsy were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.26, 95% CI 1.05-1.51, P = .014) and positive conjunctival staining (for each additional unit of staining 1.46; 95% CI 1.39-1.53, P < .001) or corneal staining (for each additional unit of staining 1.14; 95% CI 1.08-1.21, P < .001). The odds of having a positive serology were significantly higher among those with an abnormal Schirmer I test (adjusted OR = 1.3; 95% CI 1.09-1.54, P = .004) and conjunctival staining (adjusted OR = 1.51; 95% CI 1.43-1.58, P < .001). CONCLUSIONS In addition to corneal staining, which was associated with a higher likelihood of having a positive LSG biopsy, conjunctival staining and abnormal Schirmer I testing are of critical importance to include when screening dry eye patients for possible SS, as they were associated with a higher likelihood of having a positive LSG biopsy and serology.
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Novaes P, Diniz Grisolia AB, Smith TJ. Update on thyroid-associated Ophthalmopathy with a special emphasis on the ocular surface. Clin Diabetes Endocrinol 2016; 2:19. [PMID: 28702253 PMCID: PMC5471935 DOI: 10.1186/s40842-016-0037-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/10/2016] [Indexed: 01/08/2023] Open
Abstract
Thyroid-associated ophthalmopathy (TAO) is a condition associated with a wide spectrum of ocular changes, usually in the context of the autoimmune syndrome, Graves’ disease. In this topical review, we attempted to provide a roadmap of the recent advances in current understanding the pathogenesis of TAO, important aspects of its clinical presentation, its impact on the ocular surface, describe the tissue abnormalities frequently encountered, and describe how TAO is managed today. We also briefly review how increased understanding of the disease should culminate in improved therapies for patients with this vexing condition.
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Affiliation(s)
- Priscila Novaes
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI 48105 USA
| | - Ana Beatriz Diniz Grisolia
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI 48105 USA
| | - Terry J Smith
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI 48105 USA.,Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105 USA.,Department of Ophthalmology and Visual Sciences, Brehm Tower, Room 7112, 1000 Wall Street, Ann Arbor, MI 48105 USA
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Huh HD, Kim JH, Kim SJ, Yoo JM, Seo SW. The Change of Lacrimal Gland Volume in Korean Patients with Thyroid-associated Ophthalmopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:319-325. [PMID: 27729751 PMCID: PMC5057007 DOI: 10.3341/kjo.2016.30.5.319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe the change of lacrimal gland volumes in Korean patients with thyroid-associated ophthalmopathy (TAO) via computed tomography (CT). METHODS A retrospective review of CT images from 217 TAO patients and 135 control subjects was performed. The TAO patients were diagnosed between May 2005 and May 2014 and had a CT performed on initial presentation (330 orbital CT scans). These images were compared with 270 orbital CT scans from the control group, obtained between May 2013 and May 2014. An open source DICOM viewer was used to calculate the volume of the lacrimal gland. RESULTS The mean volume of the lacrimal gland in TAO patients was 0.816 cm3 in the right orbit (standard deviation [SD], 0.048) and 0.811 cm3 in the left orbit (SD, 0.051), with no significant difference between right and left (p = 0.192). However, significant differences were observed between TAO patients and healthy individuals (p < 0.001). There was no significant difference between mean lacrimal gland volumes of males (0.812 cm3; SD, 0.037) and females (0.816 cm3; SD, 0.029) (p = 0.513). There was a negative correlation between gland volume and age in TAO patients (Pearson r = -0.479, p = 0.00). The subjective tearing (right: r = 0.244, p = 0.018; left: r = 0.226, p = 0.024), corneal superficial punctate keratopathy (right: r = 0.192, p = 0.040; left: r = 0.206, p = 0.036), and exophthalmometry (right: r = 0.182, p = 0.032; left: r = 0.180, p = 0.046) correlated with lacrimal gland volume. CONCLUSIONS This study is the first to use CT images to calculate the lacrimal gland volume of Korean TAO patients. In TAO patients, the lacrimal gland volume was notably increased compared to control subjects. The lacrimal gland volume decreased with age, but there was no difference between gender and no difference between left and right. The lacrimal gland volume correlated with subjective tearing, corneal superficial punctate keratopathy and exophthalmometry.
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Affiliation(s)
- Hyoun-Do Huh
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ji-Hye Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Seong-Jae Kim
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Ji-Myong Yoo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seong-Wook Seo
- Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Chen A, Chen HT, Hwang YH, Chen YT, Hsiao CH, Chen HC. Severity of dry eye syndrome is related to anti-dsDNA autoantibody in systemic lupus erythematosus patients without secondary Sjogren syndrome: A cross-sectional analysis. Medicine (Baltimore) 2016; 95:e4218. [PMID: 27428227 PMCID: PMC4956821 DOI: 10.1097/md.0000000000004218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There are as many as one-third of the systemic lupus erythematosus (SLE) patients who suffer from dry eye syndrome. To this date, dry eye syndrome in SLE patients is believed to be caused by secondary Sjogren syndrome (sSS). However, there is increasing evidence for possible independency of dry eye syndrome and sSS in patients suffering from autoimmune diseases. The purpose of this retrospective observational case series was to identify SLE patients without sSS who had dry eye syndrome, examine the correlation of different autoantibodies and dry eye severity, and determine the cause of dry eye in these patients.We included 49 consecutive SLE patients with dry eye who visited our dry eye clinic. In order to rule out sSS, these patients were all negative for anti-Sjogren's-syndrome-related antigen A and B (anti-SSA/SSB) and had no oral symptoms. Each patient's lupus activity was determined by serological tests including antidouble-stranded DNA antibody (anti-dsDNA), complement levels (C3, C4), erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA). Severity of dry eye syndrome was determined by corneal sensation (KSen), superficial punctuate keratopathy (SPK), Schirmer-I test (Schirmer), and tear film break-up time (TBUT). The autoantibodies and the dry eye parameters in each group were tested using the χ test or the Mann-Whitney U test for normally distributed or skewed data, respectively.The anti-dsDNA showed significant correlations with KSen (P < 0.001), SPK (P < 0.001), and Schirmer (P = 0.042) but not TBUT. The C3 showed significant correlations with KSen (P < 0.001), SPK (P < 0.001), and Schirmer (P = 0.014) but not TBUT. No correlations of dry eye parameters were observed between C4, ESR, and ANA.The major finding of this study was that the severity of dry eye syndrome in SLE patients without sSS was strongly correlated with anti-dsDNA and C3 but not with C4, ESR, and ANA.
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Affiliation(s)
- Alexander Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Hung-Ta Chen
- Department of Internal Medicine, Taipei City Hospital-Heping Branch
| | - Yih-Hsiou Hwang
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Yi-Tsun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei
| | - Ching-Hsi Hsiao
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Hung-Chi Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
- Correspondence: Hung-Chi Chen, Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan District, Taoyuan, Taiwan (e-mail: )
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Ogun OA, Adeleye JO. Severe Ophthalmological Complications of Thyroid Disease are Rare in Ibadan, Southwestern Nigeria: Results of a Pilot Study. OPHTHALMOLOGY AND EYE DISEASES 2016; 8:5-9. [PMID: 27042149 PMCID: PMC4811264 DOI: 10.4137/oed.s32169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ocular manifestations of thyroid dysfunction constitute a wide clinical spectrum ranging from minor ocular discomfort, lid retraction, lid lag and ocular injection, to sight threatening eyeball protusion and optic nerve compression. Thyroid-related eye disorders are most commonly associated with Graves’ disease, and this most frequently occurs in the setting of hyperthyroidism. However, in 10% of cases, typical eye signs have also been reported in euthyroid and hypothyroid states. The severity of thyroid eye disease has been linked to cigarette smoking. There is very little data specifically reporting the ocular manifestations of thyroid disease among black African patients and there is no known report from Nigeria. This pilot study therefore focused on documenting the ocular signs accompanying thyroid dysfunction in a black African population. AIM To evaluate the pattern of ocular complications, among patients treated for thyroid disorders, in a major Nigerian teaching hospital. RESULTS A total of 75 patients with thyroid dysfunction, were evaluated, comprising 63 females and 12 males. There was a very low prevalence of smoking among patients (<5%). Graves’ disease was the commonest thyroid disorder, representing 70% of cases. Seventy-eight percent of patients were hyperthyroid, 11.8% were euthyroid and only 9.8% of patients were hypothyroid. Commonest systemic symptoms were neck swelling (68.6%), weight loss (63.8%), tremors (60.9%) and palpitations (59.4%). Two-thirds of patients reported ocular symptoms consisting mainly of painless eye swelling (66.7%) and ocular irritation (58%). Conjunctival injection, lid lag and lid retraction were the commonest ocular signs. Chemosis, severe proptosis and ocular motility disorder were very rare. Optic neuropathy was found in 4 patients but was related to pre-existing glaucoma. Majority of patients required only ocular emollients and tear supplements. CONCLUSION Severe ocular complications of thyroid disorders were uncommon in this cross-section of Nigerian patients. This may be linked to the very low prevalence of cigarette smoking among Nigerians or genetic and environmental factors linked to their African heritage.
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Affiliation(s)
- Olufunmilola A Ogun
- Department of Ophthalmology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Jokotade O Adeleye
- Department of Medicine, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
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Kim YS, Kwak AY, Lee SY, Yoon JS, Jang SY. Meibomian gland dysfunction in Graves' orbitopathy. Can J Ophthalmol 2016; 50:278-82. [PMID: 26257221 DOI: 10.1016/j.jcjo.2015.05.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine morphologic changes in the meibomian glands associated with patients with Graves' orbitopathy (GO) using a novel meibography imaging system, and to evaluate its correlation with GO clinical manifestations. DESIGN Retrospective, observational case series. PARTICIPANTS Fifty-one GO patients and 31 normal control participants. METHODS This retrospective study examined 51 GO patients and 31 normal control participants. The structure of the meibomian gland was assessed using the meibography imaging system. All of the participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The tear film break-up time (BUT) was measured. The palpebral fissure height, exophthalmos, and eyelid retraction were also assessed. RESULTS The meibography score, tear film BUT, and OSDI indicated statistically significant differences between the GO and normal groups: The tear film BUT was shorter and the OSDI and meibography score were higher in the GO patient group. There was a significant negative correlation between the meibography score and the tear film BUT in GO patients (r = -.503 and p < .001). In the multivariable linear regression analysis, the meibography score of the GO patients had a positive association with exophthalmos and palpebral fissure height. CONCLUSIONS Compared with the normal control participants, GO patients had more unstable tear films and severe symptoms of dry eye. Using the meibography system, the authors found that GO patients had a higher prevalence of obstructive type meibomian gland dysfunction and changes in meibomian glands increased, with proptosis and lid fissure widening.
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Affiliation(s)
- Young Shin Kim
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Bucheon
| | - Ae Young Kwak
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul
| | - Sang Yeul Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul
| | - Jin Sook Yoon
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul
| | - Sun Young Jang
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Bucheon; Yonsei University Graduate School of Medicine, Seoul, Korea..
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Urrets-Zavalía JA, Espósito E, Garay I, Monti R, Ruiz-Lascano A, Correa L, Serra HM, Grzybowski A. The eye and the skin in endocrine metabolic diseases. Clin Dermatol 2016; 34:151-65. [DOI: 10.1016/j.clindermatol.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levy O, Labbé A, Borderie V, Laroche L, Bouheraoua N. La ciclosporine topique en ophtalmologie : pharmacologie et indications thérapeutiques. J Fr Ophtalmol 2016; 39:292-307. [DOI: 10.1016/j.jfo.2015.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 11/21/2015] [Accepted: 11/27/2015] [Indexed: 01/12/2023]
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Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy. Eur Thyroid J 2016; 5:9-26. [PMID: 27099835 PMCID: PMC4836120 DOI: 10.1159/000443828] [Citation(s) in RCA: 573] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Varese, Italy
- *Prof. Luigi Bartalena, Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri 57, IT-21100 Varese (Italy), E-Mail
| | - Lelio Baldeschi
- Department of Ophthalmology, Hospital Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | - Kostas Boboridis
- Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anja Eckstein
- Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, Germany
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Petros Perros
- Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mario Salvi
- Graves' Orbitopathy Center, Endocrinology, Fondazione Ca' Granda IRCCS, University of Milan, Milan, Italy
| | - Wilmar M. Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Gire AI, Karakus S, Ingrodi SM, Akpek EK. Frequent Dosing of Topical Cyclosporine A for Severe Ocular Surface Disease. J Ocul Pharmacol Ther 2016; 32:150-4. [PMID: 26789928 DOI: 10.1089/jop.2015.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To study the systemic safety and patient tolerability of frequent dosing of cyclosporine A (CsA) 0.05% eyedrops in the treatment of ocular surface disease. This is a retrospective case series. Patients with significant ocular surface diseases who were treated using topical CsA higher than the usual twice daily dosing (3-8 times daily and over a treatment period of 1-70 months). The main outcome measures are plasma levels of CsA and local tolerability. METHODS Symptom assessment, corneal staining using fluorescein, conjunctival staining using lissamine green, tear film breakup time, and other signs according to the disease process were monitored. Discontinuation of treatment due to intolerability was recorded. CsA levels were measured in the plasma at a clinical laboratory. RESULTS Plasma levels of CsA were below the level of detection (7 ng/mL) in all the 41 patients included. All patients tolerated the treatment well with none discontinuing due to any treatment-related local adverse effects. CONCLUSIONS This study demonstrates that CsA 0.05% ophthalmic emulsion applied more frequently than the usual twice daily dosing was safe and well tolerated in patients with significant ocular surface diseases.
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Affiliation(s)
- Anisa I Gire
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Sezen Karakus
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Shanna M Ingrodi
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Esen Karamursel Akpek
- Ocular Surface Diseases and Dry Eye Clinic, Wilmer Eye Institute, Johns Hopkins University School of Medicine , Baltimore, Maryland
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Ocular Surface Alterations and In Vivo Confocal Microscopic Features of Corneas in Patients With Newly Diagnosed Graves' Disease. Cornea 2016; 34:745-9. [PMID: 25811727 DOI: 10.1097/ico.0000000000000426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the ocular surface characteristics and corneal microstructure in patients with newly diagnosed Graves disease (GD) with no evidence of active thyroid eye disease (TED). METHODS Eighty eyes of 40 patients with newly diagnosed GD and 40 age-matched control subjects were recruited in this cross-sectional study. All participants underwent ocular surface tests in the order of tear break-up time (BUT), lissamine green (LG) staining, Schirmer I test with anesthesia, and ocular surface disease index (OSDI) questionnaire. Basal epithelial cell, keratocyte, and endothelial cell densities and subbasal nerves were evaluated using in vivo confocal microscopy (IVCM). Independent sample t test, χ test, and Mann-Whitney U test were used for statistical analysis. RESULTS Patients with GD had higher OSDI (5.9 ± 6.6 vs. 1.7 ± 2.4, respectively, P ≤ 0.001) and LG staining scores (0.5 ± 0.6 vs. 0.2 ± 0.4, respectively, P = 0.003), and lower BUT scores (7.3 ± 2.5 vs. 9.9 ± 1.7, respectively, P < 0.001) compared with those of control subjects. Patients with GD had lower mean basal epithelial cell density (3928 ± 657 cells/mm² vs. 4771 ± 622 cells/mm², respectively) and total subbasal nerve density (958 ± 394 cells/mm² vs. 1416 ± 744 cells/mm², respectively) and higher subbasal nerve tortuosity (2.7 ± 0.8 vs. 1.6 ± 0.6, respectively) compared with those of control subjects (P < 0.001). There was a statistically significant negative correlation between the duration of symptoms of hyperthyroidism and BUT (rho = -0.273, P = 0.014) and a positive correlation between LG staining scores (rho = 0.329, P = 0.003). A significant reduction in BUT (rho = -0.238, P = 0.003) and epithelial cell density (rho = -0.174, P = 0.029) and an increase in OSDI scores (rho = 0.328, P = 0.003) were found with increasing exophthalmometry measurements. CONCLUSIONS Ocular surface alterations begin early in the course of Graves disease before the onset of overt TED.
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Management of Dry Eye in Sjögren’s Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE The aim of this study was to review the frequency and types of inflammatory systemic diseases in a cohort of patients with dry eye, and identify clinical features suggesting the presence of these. METHODS Consecutive new patients with a primary diagnosis of dry eye evaluated at a tertiary dry eye center between January 2010 and December 2011 were reviewed retrospectively. Standardized questionnaires were used to obtain data regarding systemic symptoms, previous medical diagnoses, and family history. Dry eye evaluations included Schirmer testing, tear film break-up time, corneal fluorescein staining, and bulbar conjunctival lissamine green staining. Clinically significant dry eye was defined as having a Schirmer test score without anesthesia of ≤10 mm or conjunctival lissamine green staining of ≥1 using the Oxford scale. RESULTS A total of 228 new patients were analyzed. Of these, 47.4% (108/228) presented with a known diagnosis of inflammatory disease. Based on a review of systems and ocular examination, 81 patients (81/228) underwent a further work-up that revealed 25 additional diagnoses that were not known on presentation. The most common newly identified conditions included occult thyroid eye disease (n = 20), primary Sjögren Syndrome (4), and Sjögren Syndrome suspect (1). Female gender, family history of autoimmune disease, self-reported joint pain or dry mouth, external signs of orbital inflammation, and conjunctival chemosis were more common in patients with inflammatory systemic disease as compared with that in patients with no identifiable condition (P < 0.05 for all). CONCLUSIONS Systemic inflammatory diseases are frequently associated with dry eye in patients evaluated at a tertiary academic center. Diagnostic evaluations may help uncover previously undiagnosed significant conditions in about one-third of tested patients.
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Ocular and systemic morbidity in a longitudinal cohort of Sjögren's syndrome. Ophthalmology 2014; 122:56-61. [PMID: 25178806 DOI: 10.1016/j.ophtha.2014.07.026] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/28/2014] [Accepted: 07/12/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report vision-threatening ocular manifestations of primary Sjögren's syndrome (SS). DESIGN Retrospective review. PARTICIPANTS Consecutive patients evaluated at an SS center between January 2007 and May 2011. METHODS Data collection was completed in March 2013. The 2002 American-European consensus criteria were used for diagnosis of SS. MAIN OUTCOME MEASURES Frequency of extraglandular ocular findings and timing of their diagnosis relative to that of SS and dry eye were assessed. RESULTS One hundred sixty-three patients were included. Almost all patients (98%) had a history of dry eye for an average of 10.4 years (median, 7.9 years) before presentation. One or more extraglandular ocular manifestations were present in 40 patients (25%), and vision-threatening findings were present in 22 patients (13%). Twelve patients (55%) with a vision-threatening ocular finding did not have a diagnosis of SS at presentation. Sixty-eight patients (42%) had extraglandular systemic manifestations of SS. Patients with vision-threatening ocular findings were 3.9 times more likely to have systemic involvement (95% confidence interval, 1.4-11.0; P = 0.010). Peripheral neuropathy, interstitial nephritis, and vasculitis were more common in those with vision-threatening ocular findings compared with patients without (P < 0.05 for all). CONCLUSIONS These results from a tertiary referral-based cohort demonstrate that primary SS frequently is associated with ocular and systemic complications. Dry eye precedes these findings on average by 1 decade. Therefore, ophthalmologists should consider assessing for SS in patients with clinically significant dry eye.
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Calculated Computed Tomography Volumes of Lacrimal Glands and Comparison to Clinical Findings in Patients With Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2014; 30:116-8. [DOI: 10.1097/iop.0000000000000015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pawlowski P, Mysliwiec J, Mrugacz M, Zak J, Bakunowicz-Lazarczyk A, Rejdak R, Wysocka J, Gorska M. Elevated percentage of HLA-DR⁺ and ICAM-1⁺ conjunctival epithelial cells in active Graves' orbitopathy. Graefes Arch Clin Exp Ophthalmol 2014; 252:641-5. [PMID: 24562464 PMCID: PMC3968517 DOI: 10.1007/s00417-014-2580-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/27/2013] [Accepted: 01/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background To evaluate if conjunctival epithelial cells’ expression of HLA-DR and ICAM-1 could be helpful as early topical markers of inflammation in Graves’ orbitopathy (GO). Methods The ocular examination evaluated a clinical activity score (CAS) by assessment of clinical features, (e.g., eyelid or conjunctival inflammation, lid width, lid closure, proptosis, ocular motility). Conjunctival epithelial cell specimens for flow-cytometric evaluations of ICAM-I and HLADR expression were collected by impression cytology from ten eyes with active GO (CAS ≥ 4 and duration ≤ 12 months), from 15 eyes with Graves’ disease (GD) without active GO (CAS 0–2) and from 15 normal specimens without any ocular disorders. Results The percentage of HLA-DR + conjunctival epithelial cells was significantly elevated in patients with active GO comparing to GD without active GO and healthy controls, 10.7 % (8.5–17.7) and 7.78 % (3.92–10.1) (p < 0.05) vs. control 4.89 % (3.5–5.5) (p < 0.005), respectively. The expression of ICAM − 1+ conjunctival epithelial cells was greater only in patients with GO vs. controls, 5.5 % (4.8–7.03) and 1.46 % (0.69–2.51) (p < 0.005), respectively. Conclusion The percentage of HLA-DR+ and ICAM-1+ conjunctival epithelial cells in patients with the active GO may serve as a topical inflammation marker in Graves’ orbitopathy.
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Affiliation(s)
- P Pawlowski
- Department of Pediatric Ophthalmology with Strabismus Treatment Unit, Medical University of Bialystok, 17 Waszyngtona Str, 15-274, Bialystok, Poland,
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Bruscolini A, Abbouda A, Locuratolo N, Restivo L, Trimboli P, Romanelli F. Dry Eye Syndrome in Non-Exophthalmic Graves' Disease. Semin Ophthalmol 2014; 30:372-6. [PMID: 24460515 DOI: 10.3109/08820538.2013.874491] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present study aims to assess qualitative and quantitative characteristics of tear film and corneal related impairment and to evaluate the quality of life in a cohort of non-exophthalmic Graves' disease (GD) patients. METHODS The series comprised 50 eyes from 25 newly diagnosed GD patients with no proptosis. As control group, 56 eyes of 28 thyroid disease-free subjects were enrolled. RESULTS The results of Schirmer I and II, break-up time, and Oxford scheme showed a significant difference between GD and controls. By ocular surface disease index (OSDI) questionnaire, eleven (44%) GD patients had normal ocular surface, while two (8%) had mild, four (16%) had moderate, and eight (32%) had severe dry eye. The mean score of the OSDI in the GD group was significantly (p < 0.001) higher with respect to the control group. CONCLUSIONS This study shows that the tear film and cornea are damaged in newly non-exophthalmic GD subjects.
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Affiliation(s)
- A Bruscolini
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - A Abbouda
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - N Locuratolo
- b Section of Endocrinology and Diabetology, Ospedale Israelitico , Rome , Italy , and
| | - L Restivo
- a Department of Ophthalmological Sciences , Sapienza University , Rome , Italy
| | - P Trimboli
- b Section of Endocrinology and Diabetology, Ospedale Israelitico , Rome , Italy , and
| | - F Romanelli
- c Department of Experimental Medicine , Sapienza University , Rome , Italy
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Abstract
Graves' ophthalmopathy (GO) is an autoimmune disorder of the orbit that is clinically relevant in 25-50% of patients with Graves' disease and 2% of patients with chronic thyroiditis. The age-adjusted annual incidence of clinically relevant GO is 16 per 100,000 population in women and 2.9 in men. At the onset of ophthalmopathy, 80-90% of patients have hyperthyroidism, with the rest having euthyroidism or hypothyroidism. The natural history of GO consists of two phases: an active inflammatory phase and a static phase. Anti-inflammatory therapy is indicated for the first phase of GO. Approximately 5% of patients experience late reactivation of GO. Asians appear to have less severe manifestations, with milder orbital edema, proptosis and muscle restriction. Genetic, anatomic and environmental factors influence the development of GO. Aging, thyroid dysfunction, thyroid stimulating hormone (TSH) receptor antibodies, smoking and radioiodine treatment for hyperthyroidism also influence the development and course of GO.
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Affiliation(s)
- Yuji Hiromatsu
- Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Japan
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Sizmaz S, Altan-Yaycioglu R, Bakiner OS, Bozkirli E, Coban-Karatas M, Ulas B. Assessment of tear meniscus with optical coherence tomography in thyroid-associated ophtalmopathy. Curr Eye Res 2013; 39:323-8. [PMID: 24215623 DOI: 10.3109/02713683.2013.847960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the tear-film meniscus with optical coherence tomography (OCT) in patients with Graves' disease (GD). MATERIALS AND METHODS Patients with GD without clinical features of thyroid-associated ophthalmopathy (TAO) (Group 1, n=35), patients with signs of TAO (Group 2, n=31) and healthy participants (Group 3, n=31) were enrolled. Palpebral fissure width, Schirmer test, tear break-up time (TBUT) test and tear-film meniscus height and area obtained with Fourier-domain-OCT were analyzed. RESULTS TBUT test scores were 8 s (2-25) in Group 1, 8 s (2-15) in Group 2 (p=0.380); and 10 s (5-17) in Group 3 (p=0.000 Group 1 versus 3, and 0.000 for Group 2 versus 3). Tear-film meniscus height did not significantly differ between Groups 1 and 2 (257.5 µm (86-962) and 258 µm (99-1340), respectively, p=0.980). In Group 3, tear-film meniscus height was 316 µm (122-720) (p=0.005 Group 1 versus 3 and 0.004 for Group 2 versus 3). Tear-film meniscus area did not significantly differ between Groups 1 and 2 (0.025 mm(2) (0.004-0.250) and 0.024 mm(2) (0.003-0.316), respectively, p=0.850). In Group 3, tear-film meniscus area was 0.048 mm(2) (0.006-0.75) (p=0.000 Group 1 versus 3 and 0.000 for Group 2 versus 3). CONCLUSION Tear function is significantly disturbed in GD. OCT is an effective way to assess the tearing function also in patients with GD.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Plastic Unit, Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
The aim of this study was to explore whether IL-7 participates in the pathogenesis of Graves' ophthalmopathy (GO). This was a prospective study. 20 GO patients (40 eyes) and 20 healthy volunteers (40 eyes) were recruited. The tear concentration of IL-7 was measured using ELISA assay. IL-7 expression in orbital tissues was evaluated by immunohistochemistry. Patients with inactive GO had the highest IL-7 concentrations in the tears, followed by healthy controls and patients with active GO per ELISA. Immunohistochemistry analysis showed that IL-7 expression in orbital tissues of the inactive GO samples was higher than that of the volunteers. Changes of IL-7 expression in different phases of GO suggested that IL-7 may play an important role in the pathogenesis of GO.
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Affiliation(s)
- KeBo Cai
- Department of Ophthalmology, Changzheng Hospital Affiliated the Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
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