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Graves` orbitopathy: frequency of ocular hypertension and glaucoma

SILVA, F. L. M. da; RODRIGUES, M. de Lourdes Veronese; AKAISHI, P. M. S.; CRUZ, A. A. V.
Fonte: NATURE PUBLISHING GROUP Publicador: NATURE PUBLISHING GROUP
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.56%
Purpose To determine the relationship between ocular hypertension and glaucoma in patients with Graves` orbitopathy. Methods A total of 107 patients with a diagnosis of Graves` orbitopathy, followed at the Oculoplasty sector of the University Hospital, Medical School of Ribeirao Preto, were evaluated by applanation tonometry, computed visual campimetry (Humphrey 30-2, Full Threshold) and analysis and photographic documentation of the optic nerve. The patients considered to have the suspicion of glaucoma were re-evaluated 1 year later for diagnostic confirmation or exclusion. Results A 3.74% prevalence of ocular hypertension (four patients) and a 2.8% prevalence of glaucoma (three patients) was observed. When considering only patients older than 40 years, the prevalence of ocular hypertension was 5.4% (four patients) and the prevalence of glaucoma was 4.76% (three patients). Conclusion The present study did not reveal a statistically significant difference in the prevalence of ocular hypertension or glaucoma between patients with Graves` orbitopathy and the general population.; CAPES, Brazil

Pre- and Postoperative Quantitative Analysis of Contour Abnormalities in Graves Upper Eyelid Retraction

Ribeiro, Sara F. T.; Milbratz, Gherusa H.; Garcia, Denny M.; Devoto, Martin; Neto, Guilherme H.; Moerschbaecher, Ricardo; Pereira, Filipe J.; Cruz, Antonio A. V.
Fonte: LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA Publicador: LIPPINCOTT WILLIAMS & WILKINS; PHILADELPHIA
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.52%
Purpose: One of the most common problems of the surgical management of Graves upper eyelid retraction is the occurrence of eyelid contour abnormalities. In the present study, the postoperative contour of a large sample of eyelids of patients with Graves orbitopathy was measured. Methods: The postoperative upper eyelid contour of 62 eyes of 43 patients with Graves orbitopathy was subjectively classified by 3 experienced surgeons in 3 categories: poor, fair, and good. The shape of the eyelid contours in each category was then measured with a recently developed custom-made software by measuring multiple midpupil eyelid distances each 15 degrees along the palpebral fissure. The upper eyelid contour of 60 normal subjects was also quantified as a control group. Results: The mean ratio between the sum of the lateral and medial midpupil eyelid distances (lateral/medial ratio) was 1.10 +/- 0.11 standard deviation in controls and 1.15 +/- 0.13 standard deviation in patients. Postoperatively, the mean midpupil eyelid distance at 90 degrees was 4.16 +/- 1.13 mm standard deviation. The distribution lateral/medial ratios of the eyelids judged as having good contours was similar to the distribution of the controls with a modal value centered on the interval between 1.0 and 1.10. The distribution of lateral/medial ratios of the eyelids judged as having poor contour was bimodal...

Avaliação da veia oftálmica superior por meio do Doppler colorido nas diferentes formas e estágios da orbitopatia de Graves; Evaluation of the superior ophthalmic vein by color Doppler in different forms and stages of Graves Orbitopathy

Angotti Neto, Helio
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 28/01/2011 PT
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46.68%
INTRODUÇÃO: A orbitopatia de Graves é uma doença autoimune cujas manifestações clínicas ocorrem por infiltração tecidual inflamatória. Apresenta estágio ativo inicial e estágio sequelar posteriormente, podendo se manifestar nas formas clínicas miogênica ou lipogênica. A inflamação da órbita pode gerar importante congestão, agravando manifestações clínicas e comprometendo o sucesso da terapia específica em alguns pacientes. O objetivo deste trabalho é a avaliação da congestão orbitária feita pelo estudo das características do fluxo sanguíneo na veia oftálmica superior, por meio do Doppler colorido de órbitas, nos grupos de pacientes com orbitopatia de graves em fase ativa, em fase sequelar miogênica e em fase sequelar lipogênica, além do grupo controle. MÉTODOS: Estudo transversal prospectivo realizado entre maio de 2006 e abril de 2008 no Serviço de Órbita do HCFMUSP. Noventa órbitas de 46 pacientes com orbitopatia de Graves foram incluídas, assim como 38 órbitas de 20 pacientes do grupo controle. Foi feito exame oftalmológico completo e avaliação pelo DCO em todos os pacientes. Pacientes com orbitopatia de Graves foram divididos em grupos com doença em atividade e doença em estágio sequelar nas apresentações miogênicas ou lipogênicas. O sentido...

Detecção da neuropatia óptica distireoidiana pela quantificação dos músculos extra-oculares e da gordura orbitária na tomografia computadorizada; Predicting dysthyroid optic neuropathy using computed tomography quantitative analysis of extraocular muscles and orbital fat

Gonçalves, Allan Christian Pieroni
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 21/09/2012 PT
Relevância na Pesquisa
36.56%
OBJETIVO: avaliar a capacidade de índices de preenchimento muscular da órbita, calculados a partir de medidas na tomografia computadorizada de multidetectores, detectar a neuropatia óptica distireoidiana em pacientes com orbitopatia de Graves. MÉTODOS: noventa e três pacientes com diagnóstico de orbitopatia de Graves foram prospectivamente estudados. Todos os pacientes foram submetidos a um exame oftalmológico completo e à tomografia computadorizada de multidetectores. Na estação de trabalho do tomógrafo foram calculados índices baseados em medidas lineares, de área e de volume de preenchimento muscular da órbita. O índice linear de Barrett, foi calculado a partir da relação entre a medida dos músculos extra-oculares em cortes coronais no ponto médio do nervo óptico orbitário e o diâmetro da órbita na mesma posição. Nesse mesmo corte coronal uma escala de 0 a 3 foi utilizada para categorizar o grau do preenchimento muscular e de compressão do nervo óptico segundo método descrito por Nugent e colaboradores. Medidas de área foram realizadas de cortes coronais a 12, 18 e 24 mm da linha interzigomática. Três índices de área foram calculados estimando-se a razão entre a área dos músculos extraoculares e a do continente ósseo medidas. Herniação de gordura orbitária pela fissura orbitária superior foi registrada como presente ou ausente conforme método descrito por Birchall e colaboradores. Dois índices volumétricos foram calculados...

Gene expression of estrogen receptor-alpha in orbital fibroblasts in Graves’ ophthalmopathy

Cury,Sarah Santiloni; Oliveira,Miriane; Síbio,Maria Teresa; Clara,Sueli; Luvizotto,Renata De Azevedo Melo; Conde,Sandro; Jorge,Edson Nacib; Nunes,Vania dos Santos; Nogueira,Célia Regina; Mazeto,Gláucia Maria Ferreira da Silva
Fonte: Sociedade Brasileira de Endocrinologia e Metabologia Publicador: Sociedade Brasileira de Endocrinologia e Metabologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2015 EN
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26.73%
Graves’ ophthalmopathy (GO) is one of the most severe clinical manifestations of Graves’ disease (GD), and its treatment might involve high-dose glucocorticoid therapy. The higher incidence of GO among females, and the reported association between polymorphisms of estrogen receptor (ER) and GD susceptibility have led us to question the role of estrogen and its receptor in GO pathogenesis. We, thus, assessed estrogen receptor-alpha (ERA) gene expression in cultures of orbital fibroblasts from a patient with GO before (controls) and after treatment with 10 nM and 100 nM dexamethasone (DEX). Orbital fibroblasts showed ERA gene expression. In the cells treated with 10 nM and 100 nM DEX, ERA gene expression was, respectively, 85% higher and 74% lower, than in the control group. We concluded that ERA gene expression is found in the orbital fibroblasts of patient with GO, which may be affected by glucocorticoids in a dose-related manner. Arch Endocrinol Metab. 2015;59(3):273-6

Prostaglandin E2 elicits a morphological change in cultured orbital fibroblasts from patients with Graves ophthalmopathy.

Smith, T J; Wang, H S; Hogg, M G; Henrikson, R C; Keese, C R; Giaever, I
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 24/05/1994 EN
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46.88%
Fibroblasts derived from distinct anatomical regions appear to differ in regard to their behavior in culture. These differences may reflect functions of these cells in vivo that are tissue specific. Moreover, intrinsic differences in fibroblasts may underlie the site-specific connective tissue manifestations associated with systemic disease. We have demonstrated previously that orbital fibroblasts exhibit different cytokine response domains and protein synthetic programs when compared to those emanating from the skin. In the present communication, we demonstrate that prostaglandin E2 (PGE2) elicits in cultured human orbital fibroblasts from patients with Graves ophthalmopathy a rapid and dramatic change in cell morphology in vitro as assessed by phase-contrast and scanning electron microscopy. The central areas of the cells become elevated with respect to the plane of the substratum and are stellate, with long processes that touch neighboring cells. These changes occur within 6 hr of prostanoid addition to culture medium at an apparent concentration threshold of approximately 10 nM. Shape changes are accompanied by marked alterations in monolayer impedance as assessed by electric cell-substrate impedance sensing as described previously. Both morphologic and impedance changes elicited by PGE2 revert over 24 hr toward those found in untreated cells despite the continued presence of the prostanoid in the culture medium. In contrast...

ß-2-Adrenergic receptor gene polymorphism confers susceptibility to Graves disease

JAZDZEWSKI, KRYSTIAN; BEDNARCZUK, TOMASZ; STEPNOWSKA, MAGDALENA; LIYANARACHCHI, SANDYA; SUCHECKA-RACHON, KRYSTYNA; LIMON, JANUSZ; NARKIEWICZ, KRZYSZTOF
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/2007 EN
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36.59%
Graves disease (GD) is an autoimmune disorder with genetic predisposition. The polymorphisms 47A→G (Arg16Gly) and 79C→G (Gln27Glu) of the adrenergic ß-2 receptor (ADRB2) gene in the 5q32 region affect the functional reaction to adrenergic stimulation, which contributes to the regulation of immunological response. The -367T→C polymorphism within the 5’-leading regulatory sequence affects ADRB2 transcriptional activity. The aim of the present study was to investigate whether ADRB2 gene variants are associated with susceptibility to GD. All polymorphisms were studied in Polish GD patients (n=300) and healthy control subjects without a family history of autoimmune disorders (n=301). Genotypes were determined by the MassARRAY™ system (Sequenom, San Diego, CA). Gly16 and Gln27 allele frequencies were 61.4% and 55.2% among healthy controls, almost the same as previously reported in 4441 white participants of a cardiovascular health study. We found a higher risk of GD in Gln27 carriers (CC or CG genotypes) than in Glu27 homozygous (GG genotype) participants (OR=1.99, 95% CI: 1.27-3.12, p=0.003, pcorr=0.03). The frequency of the 79GG protective genotype was significantly smaller in the GD patients without symptoms of Graves ophthalmopathy compared to controls (10% vs 22%...

Radiotherapy in the treatment of Graves ophthalmopathy—to do it or not?

Zygulska, Aneta
Fonte: Humana Press Inc Publicador: Humana Press Inc
Tipo: Artigo de Revista Científica
Publicado em 06/10/2009 EN
Relevância na Pesquisa
47.06%
To the objective of this study is to evaluate the role and toxicity of radiotherapy in the treatment of Graves ophthalmopathy. In the years 2000–2003, 121 patients with malignant exophthalmos were treated with radiotherapy of the retrobulbar area to the total dose of 20 Gy in ten fractions with a 6 MeV photon beam. The treatment was performed by the team of the Clinic of Oncology of the Jagiellonian University Medical College in Cracow. The radiotherapy was preceded by intravenous steroid therapy: methylprednisolone acetate administered at the dose of 2 g/week for four consecutive weeks. The highest efficacy, expressed as improvement of all ocular symptoms, was observed for the combined treatment. Female and non-diabetic patients responded positively to the combined treatment. Radiotherapy combined with steroid therapy in the treatment of Graves ophthalmopathy seems to be an effective treatment for strictly defined indications. In the treatment of Graves–Basedow disease, radiotherapy is a well-tolerated treatment modality. Diabetes is a factor that worsens prognosis in Graves ophthalmopathy and female sex is a favourable factor for this condition.

Transcaruncular Medial Wall Orbital Decompression: An Effective Approach for Patients with Unilateral Graves Ophthalmopathy

Hill, Robert H.; Czyz, Craig N.; Bersani, Thomas A.
Fonte: The Scientific World Journal Publicador: The Scientific World Journal
Tipo: Artigo de Revista Científica
Publicado em 30/04/2012 EN
Relevância na Pesquisa
46.93%
Purpose. To evaluate the reduction in proptosis, incidence of postoperative diplopia, and postoperative globe symmetry after transcaruncular medial wall decompression in patients with unilateral Graves ophthalmopathy. Methods. Retrospective review of 16 consecutive patients who underwent unilateral transcaruncular medial wall orbital decompression from 1995 to 2007. The diagnosis of Graves ophthalmopathy was based on history and clinical findings including proptosis, lagophthalmos, lid retraction, motility restriction, and systemic thyroid dysfunction. Results. The mean reduction in proptosis was 2.3 mm. The mean difference in exophthalmometry preoperatively between the two eyes in each patient was 3.1 mm whereas postoperatively the mean difference was 1.1 mm (P = 0.0002). Eleven of 16 patients (69%) had 1 mm or less of asymmetry postoperatively. There was no statistically significant difference in the incidence of diplopia pre and postoperatively (P = 1.0). Conclusions. Medial wall orbital decompression is a safe and practical surgical approach for patients with unilateral Graves orbitopathy. The procedure carries a low risk of morbidity and yields anatomic retrusion of the globe that is comparable to other more invasive methods and may yield more symmetric postoperative results.

Graves′ orbitopathy: Management of difficult cases

Wiersinga, Wilmar M.
Fonte: Medknow Publications & Media Pvt Ltd Publicador: Medknow Publications & Media Pvt Ltd
Tipo: Artigo de Revista Científica
Publicado em /12/2012 EN
Relevância na Pesquisa
36.52%
Management of Graves′ ophthalmopathy (GO) is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to discontinue smoking is straightforward, but just a small minority of smokers is able to quit smoking. Detailed information on how smoking adversely affects the outcome of Graves′ disease may convince patients they have to stop smoking right away. Controversy exists on the most appropriate treatment of Graves′ hyperthyroidism in the presence of GO. 131I therapy is associated with a risk of about 15% for worsening of GO; a preventive course of steroids is indicated in the presence of risk factors (smoking, biochemically severe hyperthyroidism, high level of TSH receptor antibodies, active GO). Alternatives are thyroidectomy or long-term treatment with antithyroid drugs, which apparently are rather neutral with respect to the course of GO. Mild GO is not always perceived as being mild by the patients themselves. Selenium improves mild GO. Moderate-to-severe GO is preferably treated with intravenous methylprednisolone pulses, but serious side effects and relapsing GO do occur. After steroid failure combination therapy with low-dose oral prednisone with either cyclosporine or retrobulbar irradiation can be effective. Dysthyroid optic neuropathy is best treated with IV pulses...

Asymmetric graves ophthalmopathy as a sole manifestation of autoimmune hypothyroidism

Verma, Sudhir Kumar; Jain, Nirdesh; Saraf, Sameer; Singh, Shailesh Kumar
Fonte: BMJ Publishing Group Publicador: BMJ Publishing Group
Tipo: Artigo de Revista Científica
Publicado em 03/01/2013 EN
Relevância na Pesquisa
46.64%
Graves ophthalmopathy (GO) is commonly associated with hyperthyroidism, however its coexistence with hypothyroidism is seen uncommonly in 5% of cases. The ophthalmic signs in GO are usually bilaterally symmetrical, however in 10–15% of cases patients may present asymmetrically. The ophthalmic signs in GO are commonly seen with other systemic features of thyroid disease, however when a patient present with asymmetric ophthalmic signs in the absence of other thyroid manifestations, it is difficult to consider the possibility of thyroid disorder, which may result in delayed diagnosis and further progression of disease. Here, we report a case of 22-year-old man who presented with progressive painless bulging of right eye without other features of thyroid disease which on workup was diagnosed as a case of autoimmune hypothyroidism.

Is radioiodine more likely than antithyroid drugs to worsen ophthalmopathy in patients with Graves disease?

Bahn, Rebecca S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
37.21%
This Practice Point commentary discusses the findings and limitations of a systematic review by Acharya et al. that assessed the utility of radioiodine to treat Graves hyperthyroidism. The authors examined 10 randomized controlled trials, and focused on the potential causative relationship between radioiodine and Graves ophthalmopathy. They concluded that the risk of Graves ophthalmopathy following radioiodine therapy is higher than that after treatment with antithyroid drugs (relative risk [RR] 4.23). The risk of severe Graves ophthalmopathy was also found to be increased after treatment with radioiodine (RR 4.35). Glucocorticoid prophylaxis was highly effective in preventing disease progression in patients with pre-existing Graves ophthalmopathy (RR 0.03). Here, I highlight the issues to consider when interpreting and generalizing these results, such as the limitations imposed by the inconsistency of disease classification and description in the various trials. Although this systematic review highlighted the small but real risk of Graves ophthalmopathy progression following radioiodine therapy, it could not provide insight into the extent of this progression or identify which patients are at highest risk and so might benefit most from prophylaxis.

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports

Eing, Felipe; Velasco e Cruz, Antonio Augusto
Fonte: CONSEL BRASIL OFTALMOLOGIA; SAO PAULO Publicador: CONSEL BRASIL OFTALMOLOGIA; SAO PAULO
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
36.37%
The purpose of the present article is to present and discuss two cases of globe subluxation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients despite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.

Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials; Radioterapia para oftalmopatia de Graves: uma revisão sistemática e meta-análise de ensaios clínicos randomizados e controlados

Viani, Gustavo Arruda; Boin, André Campiolo; De Fendi, Ligia Issa; Fonseca, Ellen Carrara; Stefano, Eduardo Jose; Paula, Jayter Silva de
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
47.02%
PURPOSE: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to clinical treatments for Graves' ophthalmopathy. The MEDLINE, EMBASE, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. RESULTS: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85-250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95%1.59-6.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.34-12.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade...

Perfil genetico de risco para doença de Graves e para a oftalmopatia de Graves em uma população brasileira; Genetic profile of risk to Graves' disease and Graves' ophthalmology in a Brazilian population

Roberto Bernardo dos Santos
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 26/02/2009 PT
Relevância na Pesquisa
47.32%
A Doença de Graves é um processo imunológico em que a combinação de fatores genéticos e ambientais é fundamental. Vários genes têm sido propostos como envolvidos no desenvolvimento da doença, particularmente os genes do sistema HLA e os polimorfismos do gene CTLA-4. Com relação à Oftalmopatia de Graves, além dos fatores genéticos, o tabagismo é conhecido como um importante fator de seu desenvolvimento. Nós previamente demonstramos que a herança de polimorfismos em genes relacionados ao metabolismo e detoxificação de xenobióticos, além de genes relacionados a apoptose celular, como TP53, tem uma importante ação na suscetibilidade para essas doenças. Nosso objetivo foi determinar as relações entre o polimorfismo do gene CTLA-4 região promotora -318, CYP1A1m1, GSTP1 e 72TP53 e os riscos para Doença de Graves e Oftalmopatia de Graves. Avaliar a relação entre fatores clínicos (idade, sexo, etnia, tabagismo, tamanho do bócio), laboratoriais (TSH, T4livre, T3total, ANTITPO, antiTg, TRAb), de imagem (captação tiroidiana com tecnécio ou iodo131) e de tipo de tratamento (radioiodo, drogas antitiroidianas e cirurgia) . Estudamos um total de 193 pacientes com Doença de Graves comparados com 200 indivíduos-controle...

Radiation therapy for Graves' ophthalmopathy: a systematic review and meta-analysis of randomized controlled trials

Viani,Gustavo Arruda; Boin,André Campiolo; De Fendi,Ligia Issa; Fonseca,Ellen Carrara; Stefano,Eduardo Jose; Paula,Jayter Silva de
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2012 EN
Relevância na Pesquisa
46.75%
PURPOSE: To evaluate the efficacy of radiotherapy (RT) with total dose of 20 Gy (RT 20 Gy) in the treatment of Graves' ophthalmopathy. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed comparing RT 20 Gy with or without glucocorticoid to clinical treatments for Graves' ophthalmopathy. The MEDLINE, EMBASE, Cochrane Library databases and recent relevant journals were searched. Relevant reports were reviewed by two reviewers. Response to radiotherapy was defined as clinical success according to each trial. We also evaluated the quality of life and whether RT to produce fewer side effects than other treatments. RESULTS: A total of 8 randomized controlled trials (439 patients) were identified. In the subgroup analysis, the overall response to treatment rates was better for: RT 20 Gy plus glucocorticoid vs glucocorticoids alone, OR=17.5 (CI95% 1.85-250, p=0.04), RT 20 Gy vs sham RT, OR= 3.15 (CI95%1.59-6.23, p=0.003) and RT 20Gy plus intravenous glucocorticoid vs RT 20Gy plus oral glucocorticoid, OR=4.15(CI95% 1.34-12.87, p=0.01). There were no differences between RT 20 Gy versus other fractionations and RT 20 Gy versus glucocorticoid alone. RT 20 Gy with or without glucocorticoids showed an improvement in diplopia grade...

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports

Eing,Felipe; Cruz,Antonio Augusto Velasco e
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2012 EN
Relevância na Pesquisa
36.37%
The purpose of the present article is to present and discuss two cases of globe su­blu­xation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients des­pite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.

Colchicine in the treatment of the inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisone

Stamato,Francisco José da Cunha; Maciel,Rui Monterio de Barros; Manso,Paulo Gois; Wolosker,Ângela Maria Borri; Paiva,Elias Rodrigues de; Lopes,Antonio Carlos; Furlanetto,Reinaldo Perrone
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2006 EN
Relevância na Pesquisa
46.61%
PURPOSE: To investigate if colchicine is valuable in the treatment of Graves' ophthalmopathy (GO), we compared its effect with prednisone in 22 patients during the inflammatory phase of GO. METHODS: All patients, similar in age, sex and smoking habits, were euthyroid for at least 3 months and randomly divided into two groups, one treated with colchicine (1.5 mg/day) and the other treated with prednisone (0.75 mg/kg/day). They were monitored with ophthalmologic assessment (clinical activity score-CAS) and magnetic resonance imaging, using a signal intensity ratio (SIR) of the recti muscles in comparison to the cerebral substantia alba. RESULTS: Amelioration of CAS was seen in 68% of the orbits in both groups. SIR also had a significant reduction after treatment: the initial median of 1.14 in G1 and 1.27 in G2, evolved, after treatment, to 1.07 in G1 and 0.69 in G2. The variation between both groups after treatment was not significant (p=0.22). None of the patients treated with colchicine had side effects; on the other hand, side effects in G2 were weight gain, edema, gastric complaints, hirsutism, weakness, depression, and alterations in blood pressure. CONCLUSION: Colchicine had a beneficial effect on the inflammatory phase of GO without the side effects of prednisone.

Cell-mediated lysis of lipid vesicles containing eye muscle protein: Implications regarding pathogenesis of Graves ophthalmopathy*

Kriss, Joseph P.; Mehdi, S. Qasim
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1979 EN
Relevância na Pesquisa
46.88%
We prepared artificial vesicles that are lysed upon cell-mediated immunological attack by human lymphocytes. These vesicles are made from a mixture of dimyristoyl lecithin, dipalmitoyl lecithin, and cholesterol, have eye muscle membrane protein (EMP) inserted into the bilayer wall, and contain intravesicular 99mTc marker. Injury to the vesicular membrane was assessed by measurement of 99mTc release. Thyroglobulin (Tg) and Tg-anti-Tg complex (TgA) bind to EMP-vesicles to an extent equal to or greater than to native eye muscle membranes in vitro; this binding requires the presence of normal human IgG. The role of Tg, TgA, IgG, and peripheral blood lymphocytes in altering membrane permeability was analyzed. Incubation of vesicles for up to 3 hr alone, with added IgG alone, or with further addition of Tg or TgA did not result in 99mTc release. Addition of lymphocytes from normal donors to the above four preparations showed release in the presence of TgA. Lymphocytes from each of eight patients with Graves ophthalmopathy caused release not only in the presence of TgA, but also in the presence of Tg. Separation of a patient's lymphocytes into high- and low-affinity rosette-formers (T and K cells, respectively) showed that cell-mediated vesicle lysis in the presence of TgA was greater with K cells than with T cells...

Antibodies targeting the calcium binding skeletal muscle protein calsequestrin are specific markers of ophthalmopathy and sensitive indicators of ocular myopathy in patients with Graves disease

Gopinath, B; Musselman, R; Beard, Nicole; El-Kaissi, S; Tani, J; Adams, Cameron L; Wall, J R
Fonte: Blackwell Publishing Ltd Publicador: Blackwell Publishing Ltd
Tipo: Artigo de Revista Científica
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We have identified several eye muscle antigens and studied the significance of the corresponding serum autoantibodies in patients with Graves' disease. Of these antigens, only calsequestrin is expressed more in eye muscle than other skeletal muscles, which could explain at least partly the specific involvement of eye muscle in patients with Graves' disease. Earlier, we found a modest relationship between anti-calsequestrin antibodies and ophthalmopathy, but in that study we used calsequestrin prepared from rabbit heart muscle and measured antibodies by immunoblotting. We have reinvestigated the prevalences of anti-calsequestrin antibodies in larger groups of well-characterized patients with thyroid autoimmunity with and without ophthalmopathy and control patients and healthy subjects, using standard enzyme-linked immunosorbent assay incorporating highly purified rabbit skeletal muscle calsequestrin, which has a 97% homology with human calsequestrin, as antigen. Anti-calsequestrin antibodies were detected in 78% of patients with active congestive ophthalmopathy, in 92% of those with active inflammation and eye muscle involvement, but in only 22% of patients with chronic, 'burnt out' disease. Tests were also positive in 5% of patients with Graves' hyperthyroidism without evident ophthalmopathy (two patients) and one patient with 'watery eyes' but no other clear signs of congestive ophthalmopathy and IgA nephropathy and no known thyroid disease...