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Chung IY, Hardy TG, Khong JJ. Dysthyroid optic neuropathy: a case series at a tertiary ophthalmic referral centre. Eye (Lond) 2024; 38:1168-1172. [PMID: 38081935 PMCID: PMC11009319 DOI: 10.1038/s41433-023-02856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/27/2023] [Accepted: 11/17/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES To determine risk factors and treatment outcomes in dysthyroid optic neuropathy (DON) at a single tertiary ophthalmic centre. METHODS Retrospective audit of DON patients who have received intravenous methylprednisolone (IVMP) therapy at Royal Victorian Eye and Ear Hospital, Melbourne, Australia from July 2015 to October 2021. RESULTS Study included 24 patients (58% female) with an average age of 59.8 ± 14.7 years at DON diagnosis. Majority (92%) had Graves' hyperthyroidism and 77% had a smoking history. At diagnosis, average visual acuity (VA) of worse eye was LogMAR 0.46, and 48% had relative afferent pupillary defect. Proptosis (89%) and diplopia (73%) were most commonly present at diagnosis. 78% showed predominantly extra-ocular muscle enlargement, and apical crowding (52%) on radiology. 38% (n = 9/24) responded to IVMP alone, 58% (n = 14/24) progressed to surgical orbital decompression. The average total cumulative dose of IVMP during DON treatment was 6.8 ± 1.9 g. 29% required further treatment after IVMP and surgical decompression, 4 (17%) had additional radiotherapy, and three (13%) required immuno-modulatory therapy. Average final VA was LogMAR 0.207, with all patients having inactive TED at final follow-up (mean 1.7 years). In refractory DON cases, 71% retained VA ≥ 6/9 and 48% had DON reversal. CONCLUSIONS DON patients typically present in late 50s, with a smoking history and predominant extra-ocular muscle enlargement. High-dose IVMP fully resolved DON in only 38%. A considerable proportion required urgent orbital decompression. Most patients retained good vision at final follow-up.
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Affiliation(s)
- In Young Chung
- Department of Ophthalmology, Austin Hospital, Heidelberg, VIC, Australia.
| | - Thomas G Hardy
- Orbital, Plastic and Lacrimal Unit. The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, VIC, Australia
| | - Jwu Jin Khong
- Department of Ophthalmology, Austin Hospital, Heidelberg, VIC, Australia
- Orbital, Plastic and Lacrimal Unit. The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Centre for Eye Research Australia, Department of Surgery, University of Melbourne, East Melbourne, VIC, Australia
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2
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Boynes AC, Enright NJ, Hardy TG, Khong JJ. Interrater reliability of photographic assessment of thyroid eye disease using the VISA classification. Int Ophthalmol 2024; 44:98. [PMID: 38376802 PMCID: PMC10879244 DOI: 10.1007/s10792-024-02934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To determine the interrater reliability (IRR) of thyroid eye disease (TED) photographic assessment using the VISA classification. To assess whether a VISA grading atlas improves ophthalmology trainees' performance in photographic assessment of TED. METHODS A prospective, partially randomized, international study conducted from September 2021 to May 2022. Online study invitation was emailed to a volunteer sample group of 68 ophthalmology college accredited consultants and trainees, and 6 were excluded from the study. Participants were asked to score 10 patient photographs of TED using only the inflammation and motility restriction components of the VISA classification. IRR was compared between groups of practitioners by their level of experience. A clinical activity grading atlas was randomized to 50% of the ophthalmology trainees. RESULTS Overall rater ICC was 0.96 for inflammation and 0.99 for motility restriction. No statistically significant difference in IRR between rater groups was identified. Trainees with a grading atlas had the highest IRR for inflammation (ICC = 0.95). Each subcomponent of the inflammation and motility restriction components of VISA classification had an ICC considered good to excellent. The mean overall rater score was 4.6/9 for inflammation and 3.5/12 for motility restriction. For motility restriction there was a reduced mean score variance among all raters when scoring photographs with more severe motility restriction. CONCLUSION IRR using the inflammation and motility restriction components of the VISA classification was excellent. A VISA grading atlas improved trainee performance in grading inflammation.
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Affiliation(s)
- Antony C Boynes
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia.
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia.
- Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia.
| | - Nicholas J Enright
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Thomas G Hardy
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jwu Jin Khong
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, 32, Gisborne Street, East Melbourne, VIC, 3002, Australia
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC, Australia
- Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
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3
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Vest SD, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Hindso TG, Holm F, Honavar SG, Khong JJ, Kirkegaard MK, McKelvie PA, Mikkelsen LH, Mulay K, Rasmussen PK, Siersma V, Sjö LD, Sniegowski MC, Thuro BA, Vemuganti GK, Heegaard S. Specific location of ocular adnexal lymphoma and mortality: an international multicentre retrospective study. Br J Ophthalmol 2023; 107:1231-1238. [PMID: 35512851 DOI: 10.1136/bjophthalmol-2021-320466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
AIMS To examine whether the specific location of ocular adnexal lymphoma (OAL) and the American Joint Committee on Cancer (AJCC) TNM tumour stage are prognostic factors for mortality in the main OAL subtypes. METHODS Clinical and survival data were retrospectively collected from seven international eye cancer centres. All patients from 1980 to 2017 with histologically verified primary or secondary OAL were included. Cox regression was used to compare the ocular adnexal tumour locations on all-cause mortality and disease-specific mortality. RESULTS OAL was identified in 1168 patients. The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=688, 59%); follicular lymphoma (FL) (n=150, 13%); diffuse large B-cell lymphoma (DLBCL) (n=131, 11%); and mantle cell lymphoma (MCL) (n=89, 8%). AJCC/TNM tumour-stage (T-stage) was significantly associated with disease-specific mortality in primary ocular adnexal EMZL and increased through T-categories from T1 to T3 disease. No associations between AJCC/TNM T-stage and mortality were found in primary ocular adnexal FL, DLBCL, or MCL. EMZL located in the eyelid had a significantly increased disease-specific mortality compared with orbital and conjunctival EMZL, in both primary EMZL and the full EMZL cohort. In DLBCL, eyelid location had a significantly higher disease-specific mortality compared with an orbital or lacrimal gland location. CONCLUSION Disease-specific mortality is associated with AJCC/TNM T-stage in primary ocular adnexal EMZL patients. Lymphoma of the eyelid has the highest disease-specific mortality in primary EMZL, and in the full cohort of EMZL and DLBCL patients.
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Affiliation(s)
- Stine Dahl Vest
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, UK
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York City, New York, USA
| | - Gerardo F Graue
- The New York Eye Cancer Center, New York City, New York, USA
| | - Hans E Grossniklaus
- Section of Ocular Oncology, Emory University Eye Center, Atlanta, Georgia, USA
| | | | - Frederik Holm
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Santosh G Honavar
- Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Lauge Hjorth Mikkelsen
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Lene Dissing Sjö
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Matthew C Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Geeta K Vemuganti
- Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, Copenhagen, Denmark
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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Ang T, Tong JY, Patel S, Khong JJ, Selva D. Orbital inflammation following COVID-19 vaccination: A case series and literature review. Int Ophthalmol 2023:10.1007/s10792-023-02747-6. [PMID: 37198501 PMCID: PMC10191082 DOI: 10.1007/s10792-023-02747-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE The purpose of the study was to report three cases of orbital inflammation following administration of the COVID-19 vaccination, manifesting as Tolosa-Hunt syndrome (THS) and orbital myositis. METHOD A retrospective case series and literature review of patients who developed orbital inflammation following a COVID-19 vaccination. RESULTS One patient presented with Tolosa-Hunt syndrome (THS) 14 days following her third (booster) COVID-19 vaccination, one patient developed orbital myositis 10 days following his first COVID-19 vaccination and one patient developed recurrent orbital myositis 1 and 7 days following her second and fourth COVID-19 vaccination. All patients received the Comirnaty vaccine (Pfizer-BioNTech). A thorough systemic autoimmune disease workup in both patients was unremarkable. Two patients had a prior history of orbital inflammation, with previous involvement of other different orbital structures. Characteristic MRI features for each pathology were observed, supporting the clinical presentation of THS and orbital myositis. There was complete resolution of THS following corticosteroids, with no recurrence at 2 months. Meanwhile, one case of orbital myositis self-resolved at 2 months without use of systemic corticosteroids, while the other patient with orbital myositis required treatment with intra-orbital steroid injections and oral corticosteroids. CONCLUSION Orbital inflammation has been recognised as a rare adverse effect following COVID-19 vaccination. We present a case series of THS and orbital myositis as varied presentations of this entity.
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Affiliation(s)
- Terence Ang
- Department of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
| | - Jessica Y Tong
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jwu Jin Khong
- Orbital, Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Dinesh Selva
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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5
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Thia B, McGuinness MB, Ebeling PR, Khong JJ. Diagnostic accuracy of Immulite® TSI immunoassay for thyroid-associated orbitopathy in patients with recently diagnosed Graves' hyperthyroidism. Int Ophthalmol 2021; 42:863-870. [PMID: 34613563 DOI: 10.1007/s10792-021-02052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE The Immulite® thyroid stimulating immunoglobulin (TSI) immunoassay is a relatively new commercial assay that has shown good diagnostic accuracy in Graves' hyperthyroidism (GH). However, its clinical utility in thyroid-associated orbitopathy (TAO) is less clear. The purpose of this study was to assess the diagnostic accuracy of the Immulite® TSI immunoassay for TAO and investigate the associations between TSI and other clinical measures. METHODS One hundred and forty patients that had been diagnosed with GH within the previous 12 months were recruited. Identification and grading of TAO were performed at enrolment and serum samples were analysed using the Immulite® TSI immunoassay. RESULTS Of the 140 participants recruited, 75 (53.6%) had TAO. Age, sex and time since GH diagnosis were similar between those with and without TAO (p ≥ 0.300). TSI level tended to decrease with increasing time from GH diagnosis (Spearman's ρ - 0.28, 95% CI - 0.43, - 0.12). TSI levels were higher among those with than those without TAO (median 4.0 vs. 2.7 IU/L, respectively, p = 0.037). There was no correlation between TSI level and inflammatory index score (ρ = 0.14, 95% CI - 0.03, 0.30) or clinical severity (p = 0.527) among those with TAO. TSI level showed poor diagnostic accuracy for TAO (area under the receiver operating characteristic curve 0.60, 95% CI 0.51, 0.70). CONCLUSIONS Although Immulite® TSI level was higher in the presence of TAO, it showed poor diagnostic accuracy and no correlation with clinical markers of TAO severity or activity.
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Affiliation(s)
- Brandon Thia
- Department of Ophthalmology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Peter R Ebeling
- Department of Medicine, Monash Medical Centre, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Jwu Jin Khong
- Department of Ophthalmology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, 3002, Australia.,Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, 3084, Australia
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6
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Abstract
Thyroid eye disease (TED) affects 25% of patients with Graves' hyperthyroidism, where 1 in 20 patients has active, moderate-to-severe disease that will require medical treatment for reducing TED activity and severity. Intravenous corticosteroid has been the mainstay of treatment for active moderate-to-severe TED. With improved understanding of the pathophysiology of TED, immunotherapy targeting different molecular pathways including T cells, B cells, cytokines and cell surface receptors have been investigated in randomised clinical trials. This review provides an overview of the current advances in medical treatment including teprotumumab, tocilizumab, rituximab and mycophenolate and the indications for their use in the management of active, moderate-to-severe TED.
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Affiliation(s)
- Jwu Jin Khong
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia .,Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia
| | - Alan McNab
- Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia.,Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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7
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Hindsø TG, Esmaeli B, Holm F, Mikkelsen LH, Rasmussen PK, Coupland SE, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Sjö LD, Vemuganti GK, Thuro BA, Heegaard S. International multicentre retrospective cohort study of ocular adnexal marginal zone B-cell lymphoma. Br J Ophthalmol 2019; 104:357-362. [DOI: 10.1136/bjophthalmol-2019-314008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/27/2019] [Accepted: 05/11/2019] [Indexed: 01/12/2023]
Abstract
Backgrounds/aimsTo date, this is the largest cohort study on extranodal marginal zone B-cell lymphoma (EMZL) of the ocular adnexa (OA). The aim of the study was to characterise the clinical features of OA-EMZL.MethodsA retrospective multicentre study involving seven international eye cancer centres. Data were collected from 1 January 1980 through 31 December 2017. A total of 689 patients with OA-EMZL were included.ResultsThe median follow-up time was 42 months. The median age was 62 years (range, 8–100 years), and 55 % (378/689 patients) of patients were women. The majority of patients (82%, 558/680 patients) were diagnosed with primary OA-EMZL with Ann Arbor stage IE (90%, 485/541 patients) and American Joint Committee on Cancer stage T2 (61%, 340/557 patients) at the time of diagnosis. The orbit (66%, 452/689 patients) and the conjunctiva (37%, 255/689 patients) were the most frequently involved anatomical structures. The 5-year, 10-year and 20-year disease-specific survival (DSS) were 96%, 91% and 90%, respectively. Stage IE patients treated with external beam radiation therapy (EBRT) as monotherapy (10-year DSS, 95%) were found to have a better DSS than stage IE patients treated with chemotherapy (10-year DSS, 86%). Stage IIIE/IVE patients treated with chemotherapy and rituximab had a better DSS (10-year DSS, 96%) than stage IIIE/IVE patients treated with chemotherapy without rituximab (10-year DSS, 63%).Conclusions and relevanceEMZL is a slow-growing tumour with an excellent long-term survival. Low-dose EBRT as monotherapy should be considered in localised OA-EMZL. Rituximab-based chemotherapy should be chosen in those patients with disseminated disease.
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8
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Knudsen MKH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Khong JJ, McKelvie PA, Mulay K, Ralfkiaer E, Sjö LD, Vemuganti GK, Thuro BA, Curtin J, Heegaard S. Clinicopathological Features of Ocular Adnexal Mantle-Cell Lymphoma in an International Multicenter Cohort. JAMA Ophthalmol 2019; 135:1367-1374. [PMID: 29121219 DOI: 10.1001/jamaophthalmol.2017.4810] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance To our knowledge, the clinical features of ocular adnexal mantle-cell lymphoma (OA-MCL) have not previously been evaluated in a large multicenter cohort. Objective To characterize the clinical features of OA-MCL. Design, Setting, and Participants This retrospective multicenter study included patient data collected from January 1, 1980, through December 31, 2015, at 6 eye cancer centers in 4 countries. Medical records of 55 patients with OA-MCL were reviewed; the median length of follow-up was 33 months. Main Outcomes and Measures Overall survival, disease-specific survival, and progression-free survival were the primary end points. Results Fifty-five patients were included; ocular adnexal MCL was found to be most common in older individuals (mean age, 70 years) and men (n = 42 of 55; 76%). Patients with OA-MCL frequently presented with disseminated lymphoma (n = 34 of 55; 62%), and were likely to experience stage IVE disease (n = 35 of 55; 64%), with bilateral involvement (n = 27 of 55; 47%), tumor masses (n = 27 of 36; 75%), and involvement of the orbit (n = 32 of 55; 58%). Chemotherapy with or without external beam radiation therapy was the most frequently used treatment. Overall survival rates for the entire cohort were 65% at 3 years (95% CI, 52%-78%) and 34% at 5 years (95% CI, 21%-47%). Disease-specific survival after 5 years was 38% for the entire cohort (95% CI, 25%-51%); the disease-specific survival adjusted by eye cancer center was better in patients who had received rituximab in addition to the chemotherapy regimen (hazard ratio, 3.3; 95% CI, 1.0-14.7; P = .06). The median progression-free survival was 2.3 years (95% CI, 1.8-2.7 years) in patients who experienced recurrence after primary treatment, and 4.1 years (95% CI, 3.9-4.3 years) in patients who presented with a relapse of systemic lymphoma in the ocular adnexal region. Conclusions and Relevance These results suggest that the distinctive features of OA-MCL are its appearance in older male individuals, advanced stage and bilateral manifestation at the time of diagnosis, and aggressive course. The prognosis of patients with OA-MCL might be improved by addition of rituximab to chemotherapy treatment.
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Affiliation(s)
- Marina K H Knudsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter K Rasmussen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penny A McKelvie
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, and Ocular Pathology, LV Prasad Eye Institute, Hyderabad, India
| | - Elisabeth Ralfkiaer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene D Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India,School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Jeremy Curtin
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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9
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Olsen TG, Holm F, Mikkelsen LH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Sjö LD, Vemuganti GK, Thuro BA, Heegaard S. Orbital Lymphoma-An International Multicenter Retrospective Study. Am J Ophthalmol 2019; 199:44-57. [PMID: 30419193 DOI: 10.1016/j.ajo.2018.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate and characterize the clinical features of subtype-specific orbital lymphoma. DESIGN Retrospective, interventional case series. METHODS The study included 7 international eye cancer centers. Patient data were collected from January 1, 1980 through December 31, 2017. A total of 797 patients with a histologically verified orbital lymphoma were included. The primary endpoints were overall survival, disease-specific survival, and progression-free survival. RESULTS The median age was 64 years, and 51% of patients (n = 407) were male. The majority of lymphomas were of B-cell origin (98%, n = 779). Extranodal marginal zone B-cell lymphoma (EMZL) was the most frequent subtype (57%, n = 452), followed by diffuse large B-cell lymphoma (DLBCL) (15%, n = 118), follicular lymphoma (FL) (11%, n = 91), and mantle cell lymphoma (MCL) (8%, n = 66). Localized Ann Arbor stage IE EMZL and FL were frequently treated with external beam radiation therapy. DLBCL, MCL, and disseminated EMZL and FL were primarily treated with chemotherapy. EMZL and FL patients had a markedly better prognosis (10-year disease-specific survival of 92% and 71%, respectively) than DLBCL and MCL patients (10-year disease-specific survival of 41% and 32%, respectively). CONCLUSIONS Four lymphoma subtypes were primarily found in patients with orbital lymphoma: EMZL, DLBCL, FL, and MCL. The histologic subtype was found to be the main predictor for outcome, with EMZL and FL patients having a markedly better prognosis than DLBCL and MCL.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Brachytherapy
- Disease-Free Survival
- Female
- Humans
- Internationality
- Lymphoma/classification
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Mantle-Cell/diagnostic imaging
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Orbital Neoplasms/classification
- Orbital Neoplasms/pathology
- Positron Emission Tomography Computed Tomography
- Retrospective Studies
- Survival Rate
- Tomography, X-Ray Computed
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Holm
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah E Coupland
- Department of Clinical and Cancer Medicine, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York, New York, USA
| | | | | | - Santosh G Honavar
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India; Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penelope A McKelvie
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | - Lene Dissing Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India; Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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Varma S, Wong N, Khong JJ. Invasive <em>Neisseria gonorrhoeae</em> producing pre-septal cellulitis and keratoconjunctivitis: diagnosis and management. Med J Aust 2018; 207:269. [PMID: 28899333 DOI: 10.5694/mja17.00223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/12/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Shivesh Varma
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Nathan Wong
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
| | - Jwu Jin Khong
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC
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Khong JJ, Burdon KP, Lu Y, Leonardos L, Laurie KJ, Walsh JP, Gajdatsy AD, Ebeling PR, McNab AA, Hardy TG, Stawell RJ, Davis GJ, Selva D, Tsirbas A, Montgomery GW, Macgregor S, Craig JE. Association of Polymorphisms in MACRO Domain Containing 2 With Thyroid-Associated Orbitopathy. Invest Ophthalmol Vis Sci 2017; 57:3129-37. [PMID: 27304844 DOI: 10.1167/iovs.15-18797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Thyroid-associated orbitopathy (TO) is an autoimmune-mediated orbital inflammation that can lead to disfigurement and blindness. Multiple genetic loci have been associated with Graves' disease, but the genetic basis for TO is largely unknown. This study aimed to identify loci associated with TO in individuals with Graves' disease, using a genome-wide association scan (GWAS) for the first time to our knowledge in TO. METHODS Genome-wide association scan was performed on pooled DNA from an Australian Caucasian discovery cohort of 265 participants with Graves' disease and TO (cases) and 147 patients with Graves' disease without TO (controls). Top-ranked single nucleotide polymorphisms (SNPs) then were genotyped in individual DNA samples from the discovery cohort, and two replication cohorts totaling 584 cases and 367 controls. RESULTS In the GWAS of pooled DNA samples, several SNPs showed suggestive association with TO at genome-wide P ≤ 10-6; rs953128 located on chr10q21.1, rs2867161 on chr7q11.22, rs13360861 on chr5q12.3, rs7636326 on chr3q26.2, rs10266576 on chr 7q11.22, rs60457622 on chr3q23, and rs6110809 on chr20p12.1. However, the only SNP consistently associated with TO on individual genotyping in the discovery and replication cohorts was rs6110809, located within MACROD2 on chromosome 20p12.1. On combined analysis of discovery and replication cohorts, the minor A allele of rs6110809 was more frequent in TO than in Graves' disease controls without TO (P = 4.35 × 10-5; odds ratio [OR] = 1.77; 95% confidence interval [CI], 1.35-2.32) after adjusting for age, sex, duration of Graves' disease, and smoking. CONCLUSIONS In patients with Graves' disease, a common genetic variant in MACROD2 may increase susceptibility for thyroid-associated orbitopathy. This association now requires confirmation in additional independent cohorts.
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Affiliation(s)
- Jwu Jin Khong
- Melbourne Clinical School-Western Campus Department of Medicine, University of Melbourne, Sunshine Hospital, St. Albans, Victoria, Australia 2Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 3Department of
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yi Lu
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lefta Leonardos
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Kate J Laurie
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia 8School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Adam D Gajdatsy
- Centre for Ophthalmology and Visual Sciences, University of Western Australia, Western Australia, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Alan A McNab
- Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 11Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Victoria, Australia 3Department of Surgery, University of Melbourne, Victoria, Australia
| | - Richard J Stawell
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Garry J Davis
- South Australian Institute of Ophthalmology, University of Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, South Australia, Australia
| | - Angelo Tsirbas
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Grant W Montgomery
- Molecular Epidemiology, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Stuart Macgregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
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Copson B, McKelvie PA, Khong JJ. Massive retinal gliosis with episcleral extension. Clin Exp Ophthalmol 2017; 45:923-924. [PMID: 28516476 DOI: 10.1111/ceo.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Bridget Copson
- Department of Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Penelope A McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jwu Jin Khong
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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13
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Khong JJ, Burdon KP, Lu Y, Laurie K, Leonardos L, Baird PN, Sahebjada S, Walsh JP, Gajdatsy A, Ebeling PR, Hamblin PS, Wong R, Forehan SP, Fourlanos S, Roberts AP, Doogue M, Selva D, Montgomery GW, Macgregor S, Craig JE. Pooled genome wide association detects association upstream of FCRL3 with Graves' disease. BMC Genomics 2016; 17:939. [PMID: 27863461 PMCID: PMC5116198 DOI: 10.1186/s12864-016-3276-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 11/09/2016] [Indexed: 12/29/2022] Open
Abstract
Background Graves’ disease is an autoimmune thyroid disease of complex inheritance. Multiple genetic susceptibility loci are thought to be involved in Graves’ disease and it is therefore likely that these can be identified by genome wide association studies. This study aimed to determine if a genome wide association study, using a pooling methodology, could detect genomic loci associated with Graves’ disease. Results Nineteen of the top ranking single nucleotide polymorphisms including HLA-DQA1 and C6orf10, were clustered within the Major Histo-compatibility Complex region on chromosome 6p21, with rs1613056 reaching genome wide significance (p = 5 × 10−8). Technical validation of top ranking non-Major Histo-compatablity complex single nucleotide polymorphisms with individual genotyping in the discovery cohort revealed four single nucleotide polymorphisms with p ≤ 10−4. Rs17676303 on chromosome 1q23.1, located upstream of FCRL3, showed evidence of association with Graves’ disease across the discovery, replication and combined cohorts. A second single nucleotide polymorphism rs9644119 downstream of DPYSL2 showed some evidence of association supported by finding in the replication cohort that warrants further study. Conclusions Pooled genome wide association study identified a genetic variant upstream of FCRL3 as a susceptibility locus for Graves’ disease in addition to those identified in the Major Histo-compatibility Complex. A second locus downstream of DPYSL2 is potentially a novel genetic variant in Graves’ disease that requires further confirmation. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-3276-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jwu Jin Khong
- Melbourne Medical School Western Campus, Department of Medicine, University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia. .,Orbital, Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Heidelberg, VIC, Australia. .,Department of Ophthalmology and Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia.
| | - Kathryn P Burdon
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Yi Lu
- Statistical Genetics, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Kate Laurie
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Lefta Leonardos
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Paul N Baird
- Department of Surgery, Centre for Eye Research Australia and Ophthalmology, University of Melbourne, East Melbourne, VIC, Australia
| | - Srujana Sahebjada
- Department of Surgery, Centre for Eye Research Australia and Ophthalmology, University of Melbourne, East Melbourne, VIC, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia
| | - Adam Gajdatsy
- Centre for Ophthalmology and Visual Sciences, University of Western Australia, Western Australia, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Peter Shane Hamblin
- Melbourne Medical School Western Campus, Department of Medicine, University of Melbourne, Sunshine Hospital, 176 Furlong Road, St Albans, VIC, 3021, Australia.,Department of Endocrinology and Diabetes, Western Health, St Albans, VIC, Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Western Health, St Albans, VIC, Australia
| | - Simon P Forehan
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Anthony P Roberts
- Department of Endocrinology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Doogue
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, South Australia, Australia
| | - Grant W Montgomery
- Molecular Epidemiology, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Stuart Macgregor
- Statistical Genetics, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University of South Australia, Bedford Park, South Australia, Australia
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14
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Khong JJ, Finch S, De Silva C, Rylander S, Craig JE, Selva D, Ebeling PR. Risk Factors for Graves' Orbitopathy; the Australian Thyroid-Associated Orbitopathy Research (ATOR) Study. J Clin Endocrinol Metab 2016; 101:2711-20. [PMID: 27055083 DOI: 10.1210/jc.2015-4294] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Previous association studies suggest the development of Graves' orbitopathy (GO) is variably influenced by environmental risk factors. OBJECTIVE To determine the risk factors and predict odds for developing GO in Graves' hyperthyroidism (GH). DESIGN Case-control study. SETTING Multi-centre Australian Thyroid-associated Orbitopathy Research group consisting of tertiary endocrinology and ophthalmology outpatients and related private practices. PATIENTS OR OTHER PARTICIPANTS A total of 1042 participants with GH were designated as cases if they had GO (n = 604) and controls if they did not have GO (n = 438). MAIN OUTCOME MEASURES Primary outcome was GO risk factors and secondary outcome was dysthyroid optic neuropathy (DON) with the effects of risk factors measured by odds ratio (OR) using multiple logistic regression, adjusted for known risk factors and exploratory variables. RESULTS The odds of GO increased by 17% for each decade increase in the age of onset of GH (OR 1.17, confidence interval (CI): 1.06-1.29; P = .002) and by 7% for each year increase in the duration of GH (OR 1.07, CI: 1.05-1.10; P < .001). Smoking increased the odds for GO by 2.22 for current smoker and 2.07 for exsmoker (P < .001), compared with never smoking. The odds of GO are 86% less in Graves' patients using antithyroid medication than those not (OR 0.14, CI: 0.06-0.34; P < .001). Predictors for DON were older age, oculomotility restriction, strabismus, reduced palpebral aperture, and active GO. CONCLUSIONS This study identified increase age of onset, duration of GH, and smoking as risk factors for GO. Usage of antithyroid medication was negatively related to GO. Older patients with restricted ocular motility, strabismus, and active GO are at higher risk of DON and may benefit from early medical intervention.
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Affiliation(s)
- Jwu Jin Khong
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Sue Finch
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Chamika De Silva
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Stacey Rylander
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Jamie E Craig
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Dinesh Selva
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
| | - Peter R Ebeling
- NorthWest Academic Centre (J.J.K., C.D.S.), The University of Melbourne, St Albans, 3021, Victoria, Australia; Department of Ophthalmology (J.J.K.), Department of Surgery, The University of Melbourne, Heidelberg, 3081 Victoria, Australia; Orbital, Plastics and Lacrimal Unit (J.J.K.), The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Victoria, Australia; School of Mathematics and Statistics (S.F.), University of Melbourne, Parkville, 3052 Victoria, Australia; Department of Ophthalmology (S.R., J.E.C.), Flinders University of South Australia, Flinders Medical Centre, Bedford Park, 5042 South Australia, Australia; South Australian Institute of Ophthalmology (D.S.), University of Adelaide, Adelaide, 5000 South Australia, Australia; and Department of Medicine (P.R.E.), School of Clinical Sciences, Monash University, Clayton, 3168 Victoria, Australia
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Khong JJ, Wang LY, Smyth GK, McNab AA, Hardy TG, Selva D, Llamas B, Jung CH, Sharma S, Burdon KP, Ebeling PR, Craig JE. Differential Gene Expression Profiling of Orbital Adipose Tissue in Thyroid Orbitopathy. Invest Ophthalmol Vis Sci 2016; 56:6438-47. [PMID: 26444724 DOI: 10.1167/iovs.15-17185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We aimed to determine differentially expressed genes relevant to orbital inflammation and orbital fat expansion in thyroid orbitopathy (TO) using microarray gene profiling in a case-control study. METHODS Human orbital adipose samples were obtained from individuals with active TO (n = 12), inactive TO (n = 21), and normal controls (n = 21). Gene expression profiles were examined using microarray analysis and were compared between active and inactive TO, and between active TO and normal controls. Top ranked differentially expressed genes were validated by real-time RT-PCR in an additional eight active TO, 13 inactive TO, and 11 normal controls and correlated with gene set enrichment analysis (GSEA) and molecular pathways analysis. RESULTS Seven hundred twenty-one probes (683 genes) and 806 probes (735 genes) were significantly differentially expressed in comparing active to inactive TO and in comparing active TO to healthy controls, respectively. All selected genes were confirmed to be differentially expressed by real-time RT-PCR. Multiple top ranked genes in active versus inactive TO comparison are overrepresented by immune and inflammatory response genes. They include defensins (DEFA1, DEFA1B, DEFA3), which were overexpressed by 3.05- to 4.14-fold and TIMD4 by 4.20-fold. Markers for adipogenesis were overexpressed including SCD, FADS1, and SCDP1. Gene set enrichment analysis revealed dysregulation of epigenetic signatures, T-cell activation, Th1 differentiation, defensin pathway, cell adhesion, cytoskeleton organization, apoptosis, cell cycling, and lipid metabolism in active TO. CONCLUSIONS Active TO is characterized by upregulation of genes involved in cell-mediated immune, innate immune, and inflammatory response and enhanced orbital adipogenesis. TIMD4, DEFA1, DEFA1B, and DEFA3 genes may be involved in the innate immune-mediated orbital inflammation in TO. Epigenetic mechanisms may play a role in the pathogenesis of TO.
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Affiliation(s)
- Jwu Jin Khong
- Department of Medicine North West Academic Centre, University of Melbourne, St. Albans, Victoria, Australia 2Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Lynn Yuning Wang
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Gordon K Smyth
- Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia 4Department of Mathematics and Statistics, University of Melbourne, Parkville, Victoria, Australia
| | - Alan A McNab
- Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Thomas G Hardy
- Orbital, Plastics, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Dinesh Selva
- Department of Ophthalmic and Visual Science, University of Adelaide, South Australia, Australia
| | - Bastien Llamas
- School of Earth and Environmental Sciences, University of Adelaide, South Australia, Australia 7Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Chol-Hee Jung
- VLSCI, Life Sciences Computation Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Shiwani Sharma
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
| | - Kathryn P Burdon
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia 9Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Peter R Ebeling
- Department of Medicine North West Academic Centre, University of Melbourne, St. Albans, Victoria, Australia 10Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Bedford Park, South Australia, Australia
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Khong JJ, McNab AA, Ebeling PR, Craig JE, Selva D. Pathogenesis of thyroid eye disease: review and update on molecular mechanisms. Br J Ophthalmol 2015; 100:142-50. [PMID: 26567024 DOI: 10.1136/bjophthalmol-2015-307399] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/25/2015] [Indexed: 01/07/2023]
Abstract
Orbital changes in thyroid orbitopathy (TO) result from de novo adipogenesis, hyaluronan synthesis, interstitial oedema and enlargement of extraocular muscles. Cellular immunity, with predominantly CD4+ T cells expressing Th1 cytokines, and overexpression of macrophage-derived cytokines, perpetuate orbital inflammation. Orbital fibroblasts appear to be the major effector cells. Orbital fibroblasts express both thyrotropin receptor (TSHR) and insulin-like growth factor-1 receptor (IGF-1R) at higher levels than normal fibroblasts. TSHR expression increases in adipogenesis; TSHR agonism enhances hyaluronan production. IGF-1R stimulation leads to adipogenesis, hyaluronan synthesis and production of the chemokines, interleukin (IL)-16 and Regulated on Activation, Normal T Cell Expression and Secreted, which facilitate lymphocyte trafficking into the orbit. Immune activation uses a specific CD40:CD154 molecular bridge to activate orbital fibroblasts, which secrete pro-inflammatory cytokines including IL-1β, IL-1α, IL-6, IL-8, macrophage chemoattractant protein-1 and transforming growth factor-β, to perpetuate orbital inflammation. Molecular pathways including adenylyl cyclase/cyclic adenosine monophosphate, phophoinositide 3 kinase/AKT/mammalian target of rapamycin, mitogen-activated protein kinase are involved in TO. The emergence of a TO animal model and a new generation of TSHR antibody assays increasingly point towards TSHR as the primary autoantigen for extrathyroidal orbital involvement. Oxidative stress in TO resulting from imbalances of the oxidation-reduction state provides a framework of understanding for smoking prevention, achieving euthyroidism and the use of antioxidants such as selenium. Progress has been made in the understanding of the pathogenesis of TO, which should advance development of novel therapies targeting cellular immunity, specifically the CD40:CD40 ligand interaction, antibody-producing B cells, cytokines, TSHR and IGF-1R and its signalling pathways. Further studies in signalling networks and molecular triggers leading to burnout of TO will further our understanding of TO.
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Affiliation(s)
- Jwu Jin Khong
- North West Academic Centre, The University of Melbourne, Western Hospital, St Albans, Victoria, Australia Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia Austin Health, Department of Surgery, University of Melbourne, Heidelberg, Victoria, Australia
| | - Alan A McNab
- Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia Centre of Eye Research Australia, University of Melbourne, East Melbourne, Victoria, Australia
| | - Peter R Ebeling
- North West Academic Centre, The University of Melbourne, Western Hospital, St Albans, Victoria, Australia Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Dinesh Selva
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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17
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Munch-Petersen HD, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Prause JU, Ralfkiaer E, Sjö LD, Sniegowski MC, Vemuganti GK, Heegaard S. Ocular Adnexal Diffuse Large B-cell Lymphoma. JAMA Ophthalmol 2015; 133:165-73. [DOI: 10.1001/jamaophthalmol.2014.4644] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Helga D. Munch-Petersen
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark2Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter K. Rasmussen
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Sarah E. Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Santosh G. Honavar
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, and Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic and Lacrimal Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penny A. McKelvie
- Orbital, Plastic and Lacrimal Clinic, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, and Ocular Pathology, LV Prasad Eye Institute, Hyderabad, India
| | - Jan U. Prause
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Ralfkiaer
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene D. Sjö
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Matthew C. Sniegowski
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Geeta K. Vemuganti
- Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India11Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Steffen Heegaard
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark12Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark
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Khong JJ, Goldstein RF, Sanders KM, Schneider H, Pope J, Burdon KP, Craig JE, Ebeling PR. Serum selenium status in Graves' disease with and without orbitopathy: a case-control study. Clin Endocrinol (Oxf) 2014; 80:905-10. [PMID: 24372054 DOI: 10.1111/cen.12392] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/08/2013] [Accepted: 12/15/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Selenium is effective in improving quality of life and reducing the progression of active Graves' orbitopathy. The effect of correcting relative selenium deficiency on improving Graves' orbitopathy is unknown, as baseline selenium levels have not previously been measured. The study aims to determine whether serum selenium levels are reduced in patients with Graves' disease with orbitopathy (GO) compared with without orbitopathy (GD). DESIGN A prospective, case-control study performed between 2009 and 2012 at endocrine and ophthalmology clinics in Australia. PATIENTS A total of 198 patients with Graves' disease participated in the study: 101 with Graves' orbitopathy and 97 without Graves' orbitopathy. MEASUREMENTS Serum selenium levels in both groups. RESULTS Mean serum selenium levels were significantly lower in GO (1·10 ± 0·18 μm) than in GD (1·19 ± 0·20 μm) (P = 0·001). Mean selenium levels appeared to decrease in parallel with increasing severity of GO; selenium level was 1·19 ± 0·20 μm in GD, 1·10 ± 0·19 μm in moderate-to-severe GO and 1·09 ± 0·17 μm in sight-threatening GO (P = 0·003). Serum selenium levels remained significantly lower in GO after adjusting for age, smoking status, thyroidectomy, radioactive iodine treatment and residential location. CONCLUSION Serum selenium levels are lower in patients with GO compared with GD in an Australian study population with marginal selenium status. Relative selenium deficiency may be an independent risk factor for orbitopathy in patients with Graves' disease.
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Affiliation(s)
- Jwu Jin Khong
- NorthWest Academic Centre, The University of Melbourne, Western Health, St. Albans, Australia; Orbital Plastics and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
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Khong JJ, Hardy TG, McNab AA. Prevalence of Oculo-auriculo-vertebral Spectrum in Dermolipoma. Ophthalmology 2013; 120:1529-32. [DOI: 10.1016/j.ophtha.2013.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/18/2012] [Accepted: 01/09/2013] [Indexed: 10/26/2022] Open
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Abstract
AIM To describe a method of intrinsic optic nerve biopsy and its indications. METHODS Retrospective case series. RESULTS We report four cases that required intrinsic optic nerve biopsy for progressive optic neuropathy with uncertain diagnosis after negative systemic investigations. In all cases, a medial transconjunctival approach was used. There were no complications noted with this technique in the series, specifically there was no reported deterioration in vision. One case of neurosarcoidosis was confirmed. In the other three cases, the pathology results were non-diagnostic but ruled out serious causes such as central nervous system leukaemia relapse. CONCLUSION Medial transconjunctival intrinsic optic nerve biopsy is a minimally invasive and safe technique. The technique is suitable for sampling pathology in the distal portion of the optic nerve. Optic nerve biopsy is indicated when there is significant loss of vision from an isolated optic nerve disease and all systemic investigations have failed to identify the cause, or where the clinical course of a presumed diagnosis is atypical.
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Affiliation(s)
- Jwu Jin Khong
- The Royal Victorian Eye and Ear Hospital, Orbital Plastics and Lacrimal Unit, Melbourne, Australia.
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Abstract
OBJECTIVE This review aims to discuss the clinical application of cytogenetic and molecular testing in the diagnosis and prognosis of orbital tumors and, in so doing, highlight the basis of these methods, their advantages, and limitations. SUMMARY Specific chromosomal aberrations are detected in many lymphoproliferative neoplasms, soft tissue tumors, and in a few benign tumors of the orbit. Detection of these characteristic chromosomal translocations is most helpful to refine the diagnosis and classification, especially when the tumor is poorly differentiated and shows overlapping morphological features with another tumor type. This review outlines orbital tumors with characteristic chromosomal translocations and the relative frequency of detecting the genetic mutation. Various genetic techniques are available for genetic testing, including karyotyping, fluorescence in situ hybridization (FISH), reverse transcriptase polymerase chain reaction (RT-PCR), and genomic polymerase chain reaction (PCR). As yet, the newer methods of array-comparative genomic hybridization (array-CGH) and expression profiling are most commonly used in research settings or in large specialist centers, and their general application to cancer diagnostics is limited by their cost. Therefore, this review focuses on the methodologies that should be available to most diagnostic units. It is true that "one size does not fit all" in this field and that a combination of molecular techniques may be needed to confirm results at the genomic and transcriptional levels.
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Affiliation(s)
- Jwu Jin Khong
- South Australian Institute of Ophthalmology, Department of Ophthalmology and Visual Science, Royal Adelaide Hospital, University of Adelaide, Australia.
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Abstract
Apert syndrome is mostly caused by one of the two specific point mutations in the fibroblast growth factor receptor 2 (FGFR2). The objective of this study was to determine whether there were any differences in the prevalence of ophthalmic features in Apert syndrome when comparing the Ser252Trp and Pro253Arg mutations in FGFR2. This was a retrospective study of patients with Apert syndrome with genotype analysis. The prevalence of five ophthalmic features, visual impairment, amblyopia, strabismus, corneal abnormality, and pale optic discs, were compared between the two FGFR2 genotypes. There were 25 (74%) cases with Ser252Trp mutation, and 9 (26%) cases with the Pro253Arg mutation in FGFR2. Ophthalmic findings in 20 cases of FGFR2 Ser252Trp and 9 cases of Pro253Arg mutation were compared. Visual acuity worse than 6/12 in at least one eye was present in 60% patients with FGFR2 Ser252Trp mutation compared with 12.5% patients with Pro253Arg mutation (P < 0.05). Forty percent of eyes with FGFR2 Ser252Trp mutation compared with 12.5% eyes with Pro253Arg mutation were worse than 6/12. There was a trend of more frequent amblyopia and strabismus in FGFR2 Ser252Trp mutation and more frequent optic disc pallor in the FGFR2 Pro253Arg mutation. There was a differential effect of FGFR2 mutations in ophthalmic findings in patients with Apert syndrome, with significantly greater prevalence of visual impairment in the Ser252Trp mutation compared with the Pro253Arg mutation. Further study would elucidate whether the trends in differential effects between the two mutations in amblyopia, strabismus, and optic disc pallor represent real differences.
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Affiliation(s)
- Jwu Jin Khong
- Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Science, University of Adelaide, Adelaide, South Australia.
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Abstract
Madarosis may be a presenting feature of a number of vision and life-threatening conditions, including herpes zoster, leprosy, HIV/AIDS, trachoma, malignant eyelid tumors, discoid lupus, scleroderma, and hypothyroidism. It may occur via two broad pathogenic pathways: scarring and non-scarring, which indicates the potential for lash re-growth. Madarosis may occur as an isolated finding or together with loss of other body and scalp hair. The etiology of madarosis can be further divided into dermatological, infection, endocrine, neoplastic, drug-related, congenital, and trauma. This report includes salient points in the clinical history and examination of patients with madarosis, with an emphasis on excluding or diagnosing visual or life threatening disorders associated with madarosis.
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Affiliation(s)
- J J Khong
- Oculoplastic and Orbital Unit, Department of Ophthalmology and Visual Science, Royal Adelaide Hospital, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
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Khong JJ, Anderson P, Gray TL, Hammerton M, Selva D, David D. Ophthalmic findings in apert syndrome prior to craniofacial surgery. Am J Ophthalmol 2006; 142:328-30. [PMID: 16876521 DOI: 10.1016/j.ajo.2006.02.046] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 02/17/2006] [Accepted: 02/21/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine ophthalmic findings in patients with Apert syndrome before craniofacial surgery. DESIGN A cross-sectional retrospective study. METHODS Review of 63 cases (27 males, 36 females) with Apert syndrome without craniofacial surgery from the Australian Craniofacial Unit. Demographic data, age of presentation, and ophthalmic findings at the first presentation were recorded. RESULTS At a mean age of four years and median age of one year, at least 14% of patients had amblyopia, 60% of patients had strabismus, 19% of patients had anisometropia, and 34% of eyes had ametropia. Exposure keratopathy and corneal scarring occurred in at least 13% of patients and optic atrophy in at least 8% of patients. CONCLUSIONS This study demonstrated that patients with Apert syndrome were at risk of amblyopia because of high prevalence of refractive errors, strabismus, and anisometropia. Exposure keratopathy and corneal scarring occurred commonly.
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Affiliation(s)
- Jwu Jin Khong
- Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, Australia.
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Abstract
AIM To determine the complications associated with mitomycin C (MMC) in the treatment of ocular surface neoplasia. METHODS A retrospective and consecutive study of 100 eyes in 91 patients with ocular surface neoplasia treated with MMC in a single centre between November 1998 and January 2005. Outcome measures included complications of MMC and the treatment required for these complications. RESULTS One to three 7 day cycles of topical MMC 0.04% four times a day were given to 59 eyes with localised corneal-conjunctival intraepithelial neoplasia (CIN), 19 eyes with diffuse CIN, six eyes with recurrent CIN, one eye with ocular surface squamous cell carcinoma, three eyes with primary acquired melanosis (PAM) with atypia, nine eyes with conjunctival malignant melanoma (MM), two eyes with sebaceous carcinoma with pagetoid spread, and one eye with recurrent atypical fibroxanthoma. Nine patients had bilateral CIN. 31 (34%) cases developed an allergic reaction to MMC and 14 (14%) eyes had epiphora secondary to punctal stenosis at a mean follow up period of 26.5 months. CONCLUSION In the largest study looking at complications of topical MMC in the treatment of ocular surface neoplasia, allergic reaction and punctal stenosis are relatively common. Serious complications were not observed suggesting the safe use of MMC in mid-term follow up.
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Affiliation(s)
- J J Khong
- Department of Ophthalmology and Visual Science, Royal Adelaide Hospital, North Terrace, SA 5000, Australia
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Khong JJ, Anderson P, Gray TL, Hammerton M, Selva D, David D. Ophthalmic Findings in Apert’s Syndrome after Craniofacial SurgeryTwenty-nine Years’ Experience. Ophthalmology 2006; 113:347-52. [PMID: 16458095 DOI: 10.1016/j.ophtha.2005.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 09/29/2005] [Accepted: 10/11/2005] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To survey the spectrum of ophthalmic morbidity in Apert's syndrome after craniofacial surgery. DESIGN A retrospective study of patients with Apert's syndrome managed at the Australian Craniofacial Unit from 1975 to 2004. PARTICIPANTS Sixty-one patients (31 females and 30 males) had final ophthalmic reviews at a mean age of 9.3 years (standard deviation, 9.2; range, 0.2-48.3; median, 8.2 years). METHODS Patients were identified from the unit database, and case notes were reviewed. Cases that had < or =2 recorded variables were excluded. Demographic details, age at last ophthalmic review, and total craniofacial operations performed were documented. MAIN OUTCOME MEASURES Best-corrected visual acuity, cycloplegic refractions, strabismus, amblyopia, corneal abnormality, fundoscopic findings, and visually evoked potentials. RESULTS The average number of craniofacial operations performed was 2 (range, 1-4; median, 2). Visual impairment was found in 54% of patients in at least one eye and in 19% of patients in their better eye. The most common cause was amblyopia, with a prevalence of 35%. Optic atrophy caused visual impairment in 5% of patients and corneal scarring in 8%. Sixty-three percent of patients had strabismus with more esotropia than exotropia. Ametropia was found in 69% of patients (42% were hypermetropic and 27% were myopic). Anisometropia of > or =0.75 diopters was present in 16 cases (50%). CONCLUSIONS Visual impairment is a common finding in Apert's syndrome and amblyopia is the major cause. Ametropia, astigmatism, anisometropia, and strabismus frequently occur in patients with Apert's syndrome at final ophthalmic review. Although optic atrophy was the major cause of visual loss in the era prior to craniofacial surgery, the prevalence of optic atrophy is low since the adoption of current surgical protocols. Corneal damage also contributed toward visual impairment. Early detection and adequate management of amblyopia, timely decompressive surgery before the presence of optic atrophy, and protection of the cornea should be the management goals of ophthalmologists in craniofacial units managing these patients.
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Affiliation(s)
- Jwu Jin Khong
- Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
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Khong JJ, Chen CS, James CL, Huilgol SC, O'Donnell BA, Sullivan TJ, Selva D. Malignant fibrous histiocytoma of the eyelid: differential diagnosis and management. Ophthalmic Plast Reconstr Surg 2005; 21:103-8. [PMID: 15778662 DOI: 10.1097/01.iop.0000155858.52464.6f] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Malignant fibrous histiocytoma (MFH) is a pleomorphic soft tissue sarcoma that occurs rarely in the periocular region. The purpose of this study was to present a case series of periocular MFH and to discuss the differential diagnosis and management. METHODS This is a retrospective case review of patients diagnosed with periocular MFH from tertiary hospitals and private practices. RESULTS Four patients, two women and two men with periocular MFH, had a mean age of 81 years (range, 72 to 85 years). All tumors were <5 cm in diameter and of storiform pleomorphic histologic subtype. One was located deep and 3 presented superficially. The initial diagnoses were sarcomatoid carcinoma, atypical fibroxanthoma, and leiomyosarcoma that were subsequently reclassified as MFH. One patient had a frozen section, 1 had fast track paraffin section margin control, and 2 had no frozen section margins at the initial excisions. Histology showed 2 negative margins, 1 close margin, and 1 positive margin that were cleared with wide local excision. Local recurrence occurred in 3 cases, and of these, 1 required orbital exenteration. Adjuvant radiotherapy was given to 3 patients. One had regional node metastases. There were no distant metastases or tumor-related deaths. Mean follow-up period was 36 +/- 35 months (median, 30; range, 1 to 84 months). CONCLUSIONS This study highlights the difficulties in the clinicopathologic diagnosis of periocular MFH and in particular the distinction of more superficial tumors from atypical fibroxanthoma. The mainstay of treatment is complete surgical excision with wide margins, and consideration should be given to histologic margin control in addition to adjuvant radiotherapy.
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Affiliation(s)
- Jwu Jin Khong
- Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia
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Abstract
An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96-year-old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.
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Affiliation(s)
- Jwu Jin Khong
- Ophthalmic Oncology, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
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Khong JJ, Malhotra R, Selva D, Wormald PJ. Efficacy of endoscopic sinus surgery for paranasal sinus mucocele including modified endoscopic Lothrop procedure for frontal sinus mucocele. J Laryngol Otol 2004; 118:352-6. [PMID: 15165309 DOI: 10.1258/002221504323086534] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles. It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002). There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 +/- 1.4 days. Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.
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Affiliation(s)
- Jwu Jin Khong
- Oculoplastic and Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Adelaide and Flinders Universities, Adelaide, Australia
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Khong JJ, Wormald P, Selva D. Transcaruncular approach for the management of frontoethmoidal mucoceles: a comment. Br J Ophthalmol 2004; 88:725. [PMID: 15090440 PMCID: PMC1772139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
PURPOSE To evaluate the results of endoscopic sinus surgery (ESS) for paranasal sinus mucocoele with orbital involvement and assess the frequency with which a direct orbital approach is required in these cases. METHODS Retrospective, consecutive series of sinus mucocoeles with orbital involvement treated by ESS by a single surgeon over a 4-year period (1998-2002). RESULTS A total of 24 mucocoeles of 15 patients, including 10 frontal, eight frontoethomoidal, two ethmoidal, and four maxillary. All cases demonstrated radiological orbital extension. Globe displacement was seen in 73%. At a median follow-up of 15.5 months, the mean cumulative clinical score improved from 4.2 +/- 1.5 (range 1-7) to 0.4+/-0.7 (range 0-2). Ophthalmic symptoms and signs resolved in all patients but one who had complex sinus anatomy following neurosurgery. Minor, self-limiting complications including epistaxis and intranasal adhesions occurred in three cases. Additional endoscopic sinus surgery was required in four patients for revision of narrowed frontal sinus ostium (two), mucocoele recurrence (two), and sinus toileting (one). No cases required external sinus surgery and the average hospital in-patient stay was 2.5 +/- 1.6 days. At final follow-up, sinus ostia were patent in all excluding one case that required a stent due to disrupted anatomy. CONCLUSION ESS is effective in improving ophthalmic symptoms and signs due to paranasal sinus mucocoele. ESS may be a viable treatment for paranasal sinus mucocoele with orbital extension, and a direct orbital approach is rarely necessary.
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Affiliation(s)
- J J Khong
- Oculoplastic & Orbital Unit, Department of Ophthalmology, Royal Adelaide Hospital, University of Adelaide, Australia
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Abstract
PURPOSE To determine whether the specificity of the frequency-doubling technology (FDT) perimeter in the screening mode for glaucoma can be improved by repeating abnormal screening results. METHODS The FDT perimeter was used in C-20-5 screening mode, and the right eye was tested first. After both eyes were tested, the screening was repeated in eyes with any abnormal visual field defects on FDT perimetry. The printouts were categorized as possible visual field abnormality (zero or one miss), probable visual field abnormality (two to four misses), and definite visual field abnormality (more than five misses). A clinical ophthalmologic examination was conducted on the day of the FDT perimetry screening. RESULTS Complete data were available for 223 people. The participants ranged in age from 23 to 91 years (mean, 68.5 years; standard deviation. 13.7 years), and 119 (53%) were women. The sensitivity of the FDT perimetry screening was 100%; both cases of glaucoma showed an abnormality on FDT perimetry both times. The specificity improved moderately from the first screening to the second screening. The specificity the first time was 62% (95% confidence interval, 53.1-71.2). The specificity the second time was 68.5% (95% confidence interval, 59.8-77.1). Improvement on FDT perimetry rescreening varied by the language spoken at home. Seven of the 19 non-English speakers without glaucoma improved on rescreening, compared with none of the 23 English speakers (P = 0.002). Seven of the 25 right eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Three of 24 left eyes with FDT perimetry abnormalities both times and no glaucoma had no other detectable diseases. Of the 85 patients who did not have glaucoma but had FDT perimetry abnormalities both times, only one did not have some other detectable disease. DISCUSSION In summary, the sensitivity for glaucoma of the C-20-5 screening mode is excellent, but a paradigm for screening with the FDT perimeter to improve the overall specificity for glaucoma still must be developed.
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Affiliation(s)
- J J Khong
- Center for Eye Research, Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne
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