Thyroid ophthalmopathy (TO) is an autoimmune inflammatory disorder involving the orbit characterized by inflammation and swelling of the extraocular muscles and an increase in orbital fat and connective tissue. Despite extensive research, TO continues to be a difficult condition for the patient to cope with and for the clinician to treat. Current treatments consist of systemic immunosuppression, orbital irradiation, and surgery. It is promising for patient refractory to conventional therapy that pathogenesis of TO at molecular level which advance development of new therapies targeting cellular immunity are now better understood. Future therapies targeting immune system or specific molecules are under investigation and show promise for the future. This review will describe current trends in the management of TO, from well-established therapies such as glucocorticoids, orbital irradiation and orbital decompression to more innovative therapies targeting immune system or specific molecules involved in TO pathogenesis.
Adrenal Cortex Hormones ; Connective Tissue ; Decompression ; Glucocorticoids ; Humans ; Immune System ; Immunity, Cellular ; Immunosuppression ; Inflammation ; Muscles ; Orbit ; Therapies, Investigational ; Thyroid Gland*

No abstract available.
Follow-Up Studies ; Humans ; Limbus Corneae/*diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Melanoma/*diagnosis ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Positron-Emission Tomography ; Time Factors ; Tomography, X-Ray Computed ; Uveal Neoplasms/*diagnosis

PURPOSE: To study the changes in the amount and isoform pattern of the myosin heavy chain (MyHC) in rabbit extraocular muscle (EOM) fibers after recession. METHODS: Sixteen New Zealand white rabbits were used. Recession surgery was performed on the right superior rectus (SR) muscle by 3 mm in eight rabbits, and performed by 8 mm in other eight rabbits. The left SR muscles were left intact as the control groups. The SR muscles in both eyes were harvested from two rabbits from each recession group at 3 days and 1, 2, and 4 weeks after surgery. The changes in MyHC amount and isoform pattern were analyzed by gel electrophoresis. RESULTS: Total MyHC content decreased from 1 week after surgery in the 3-mm recessed group and from 3 days in the 8-mm group. The type IIb MyHC (MyHCIIb) plus EOM-specific MyHC (MyHCeom) showed similar proportional changes to the total MyHC at the different time points after surgery. CONCLUSIONS: The fast MyHCIIb plus the superfast MyHCeom decreased after EOM recession, and these results appear to be related to the changes in the global layer rather than in the orbital one. This suggests that the global layer might be the fast and the superfast twitch portions of rabbit EOM, which perform the fast saccades in ocular movements.
Electrophoresis ; Eye ; Muscles ; Myosin Heavy Chains ; Myosins ; Orbit ; Protein Isoforms ; Rabbits ; Saccades

PURPOSE: To study the changes in the amount and isoform pattern of the myosin heavy chain (MyHC) in rabbit extraocular muscle (EOM) fibers after recession. METHODS: Sixteen New Zealand white rabbits were used. Recession surgery was performed on the right superior rectus (SR) muscle by 3 mm in eight rabbits, and performed by 8 mm in other eight rabbits. The left SR muscles were left intact as the control groups. The SR muscles in both eyes were harvested from two rabbits from each recession group at 3 days and 1, 2, and 4 weeks after surgery. The changes in MyHC amount and isoform pattern were analyzed by gel electrophoresis. RESULTS: Total MyHC content decreased from 1 week after surgery in the 3-mm recessed group and from 3 days in the 8-mm group. The type IIb MyHC (MyHCIIb) plus EOM-specific MyHC (MyHCeom) showed similar proportional changes to the total MyHC at the different time points after surgery. CONCLUSIONS: The fast MyHCIIb plus the superfast MyHCeom decreased after EOM recession, and these results appear to be related to the changes in the global layer rather than in the orbital one. This suggests that the global layer might be the fast and the superfast twitch portions of rabbit EOM, which perform the fast saccades in ocular movements.
Electrophoresis ; Eye ; Muscles ; Myosin Heavy Chains ; Myosins ; Orbit ; Protein Isoforms ; Rabbits ; Saccades

No abstract available.
Barium* ; Child* ; Humans ; Intussusception* ; Ultrasonography*

PURPOSE: To analyze innervated myotendinous cylinders (IMCs) in the extraocular muscles (EOMs) of normal subjects and strabismic patients. METHODS: The rectus muscles of 37 subjects were analyzed. Distal myotendinous specimens were obtained from 3 normal subjects, 20 patients with acquired strabismus, 11 with infantile strabismus, and from 3 with congenital nystagmus, and were studied by using light microscopy. Some specimens (6 rectus muscles) were also examined by transmission electron microscopy. RESULTS: IMCs were found in the distal myotendinous regions of EOMs. The IMCs of patients with acquired strabismus showed no significant morphological alterations. However, significant IMCs alterations were observed at the distal myotendinous junction of patients with congenital strabismus and congenital nystagmus. CONCLUSIONS: This study supports the notion that IMCs in human EOMs function mainly as proprioceptors, along with effector properties, and a disturbance of ocular proprioceptors plays an important role in the pathogenesis of oculomotor disorder. We suggest that a proprioceptive feedback system should be stimulated and calibrated early in life for the development of binocular vision.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Microscopy, Electron, Transmission ; Middle Aged ; Oculomotor Muscles/*innervation/physiopathology/ultrastructure ; Proprioception/physiology ; Strabismus/*pathology/physiopathology ; Young Adult

Heavy menstrual bleeding (HMB) is a common problem in primary care clinic of gynecology. HMB could cause adverse effect on the quality of life of many women. This guideline will provide evidence based information concerning diagnosis and management of HMB. Constructive dialogue should allow patients to be able to trust the advice given by their practitioner as they will be confident that they have and will be able to use it to inform this decision-making process. This guideline has been developed with the aim of providing guidance on HMB. The effectiveness of the various treatments as well as their risks and benefits are discussed in relation to their use in the treatment of HMB. We wish the information contained in this guideline will help clinicians reach a reasonable and beneficial decision with the latest information.
Female ; Gynecology ; Hemorrhage ; Humans ; Menorrhagia ; Primary Health Care ; Quality of Life ; Risk Assessment

PURPOSE: To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). METHODS: A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. RESULTS: OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. CONCLUSIONS: An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.
*Tomography, Optical Coherence ; Sensitivity and Specificity ; Retrospective Studies ; Middle Aged ; Male ; Macular Degeneration/diagnosis ; Humans ; Fundus Oculi ; Fluorescein Angiography ; Female ; Diagnosis, Differential ; Cross-Sectional Studies ; Choroid Diseases/*pathology ; Choroid/*blood supply ; Aged, 80 and over ; Aged

PURPOSE: To evaluate the causes and natural course of sixth nerve palsy. METHODS: The records of 37 patients with the sixth nerve palsy were reviewed to analyze the age of onset, etiology, angle of deviation, natural course of the palsy, and percentage of intervention. RESULTS: The mean age of onset was 38.3 (3~77) years old. Causes and associations were: head trauma (n=11, 30%), idiopathic cause (n=9, 24%), neoplasm (n=7, 19%), aneurysm (n=2, 5%), and others (n=8, 22%). Complete recovery was observed in 80% of patients with nonhemorrhagic trauma and 33.3% with hemorrhagic trauma; 78% of patients with idiopathic cause; and 42.9% of patients with neoplasm. CONCLUSIONS: Head trauma was the most common cause of the sixth nerve palsy. Spontaneous complete recovery was observed in 80% of nonhemorrhagic trauma and 78% of idiopathic cases.
Abducens Nerve Diseases* ; Abducens Nerve* ; Age of Onset ; Aneurysm ; Craniocerebral Trauma ; Humans ; Paralysis

PURPOSE: To evaluate the effectiveness and safety of fine-needle aspiration biopsies of mass lesions located in the posterior orbit. METHODS: Eight patients with mass lesions in the posterior orbit underwent fine-needle aspiration biopsy with 21-gauge needles using the freehand technique. RESULTS: Fine-needle aspiration biopsies were performed easily and safely. One patient developed subconjunctival hemorrhage following biopsy, but no major complications were observed. Diagnostic specimens were obtained in 6 patients (75%). Of these diagnostic cases, 3 were benign, and the other 3 were malignant. In 3 of 6 patients we performed surgical excisions, while in the others we performed radiotherapy and/or chemotherapy. In 2 patients (25%) the cytologic specimens were inadequate. CONCLUSIONS: Fine-needle aspiration biopsy is useful and safe in evaluating orbital mass lesions, especially when they are not surgically accessible due to their location in the posterior orbit.
Biopsy* ; Biopsy, Fine-Needle* ; Drug Therapy ; Hemorrhage ; Humans ; Needles ; Orbit* ; Radiotherapy