Grave's Ophthalmopathy Research Articles

Powered Instrumentation In Orbital And Optic Nerve Decompression

Powered instrumentation in orbital and optic nerve decompression is a helpful adjunct to performing safe, functional, and complete surgery. The microdebrider and the drill are the powered instruments most often used. Combined with endoscopic visualization, these tools provide appropriate drainage and decompression whether for orbital abscesses, Grave's ophthalmopathy, or optic nerve injury.

Surgical treatment of proptosis bulbi by three-wall orbital decompression

Purpose: Three-wall orbital decompression was tested using a coronal approach as a technique. Patients and Methods: Three-wall orbital decompression by a coronal approach was performed in three patients with proptosis due to Grave's ophthalmopathy, in six patients with Grave's ophthalmopathy because their vision was threatened due to optic nerve compression, and in one patient with exorbitism due to Crouzon's syndrome for cosmetic rehabilitation. Results: Proptosis reduction averaged 4.7 mm. The technique provides good access to the orbital walls, facilitating adequate proptosis reduction, and leaves no visible scar. Diplopia, present preoperatively in four patients, was improved in three patients and unchanged in one. There was no loss of visual acuity.

2050 Megavoltage radiotherapy for severe and refractory progressive grave's ophthalmopathy comparison of scoring systems and long-term results

2050 Megavoltage radiotherapy for severe and refractory progressive grave's ophthalmopathy comparison of scoring systems and long-term results

A 64 kDa membrane antigen is a recurrent epitope for natural autoantibodies in patients with Graves' thyroid and ophthalmic diseases*

We have explored the recently described 64 kDa extraocular muscle antigen that is associated with autoantibodies in the serum of patients with severe Grave's ophthalmopathy. The localization of the antigen and the specificity of autoantibodies for both eye muscle antigens and ophthalmopathy patients were investigated. Western blotting and immunoprecipitation of metabolically labelled antigen from eye muscle and control tissues with sera from ophthalmopathy, Graves' without ophthalmopathy, and normals were used. Sera from normals (n = 9), patients with recent onset Graves' ophthalmopathy (n = 23), and patients with Graves' disease without ophthalmopathy (n = 8) were utilized. Immunoblots using detergent phase separated (amphiphilic) antigen preparations from fetal eye muscle, skeletal muscle and control tissues were quantitated. Metabolically labelled eye muscle and skeletal muscle antigens were immunoprecipitated using patient and control IgG. In the eye muscle detergent phase, immunoreactivity around 64 kDa was detected in 30% of the patients with ophthalmopathy (n = 23) as well as 38% of patients with Graves' disease and no ophthalmopathy (n = 8) and in 30% of normal sera (n = 9). There was significantly more of this anti-64 kDa reactivity in sera from the ophthalmopathy patients compared with the normals (P less than 0.01). 64 kDa reactivity to detergent phase antigens prepared from human thyroid, skeletal muscle, brain, and liver was also observed with these positive sera indicating the polyreactivity of the IgG interactions to conserved antigens in this region. We conclude that IgG antibodies binding to a recurrent 64 kDa antigen are present in many normal human sera, with increased concentrations detectable in sera from Graves' ophthalmopathy patients. Such 'specificity-crossover' with similar molecular weight transmembrane antigens is likely to be caused by natural autoantibodies reacting with recurrent autoepitopes rather than a factor aetiological in the disease process.

The Caldwell‐Luc Procedure in 1991

In the pre-antibiotic era, George Caldwell and Guy Luc both designed an operation to remove infected polypoid tissue from the maxillary antrum, as well as to provide drainage and ventilation of the sinus. With the development of antibiotics and the surgical endoscopes, many of the former indications for the Caldwell-Luc procedure have changed. However, the Caldwell-Luc procedure still offers optimal exposure for decompression of Grave's ophthalmopathy, pterygomaxillary space surgery, management of some maxillary trauma, removal of antral foreign bodies, repair of some oral-antral fistulae, management of maxillary osteomyelitis and benign maxillary tumors, and irreversible mucosal disease and endoscopic surgical failures.

The Tight Retracted Lower Eyelid

Grave's ophthalmopathy, anophthalmia, trauma, surgery, burns, and skin disorders can result in lower eyelid retraction. The retracted lower eyelid is tight in contrast to the lax lower eyelid of the common involutional ectropion. Cicatrization of the skin and muscle produces the prototype cicatricial ectropion. Downward traction on all layers of the lid rather than cicatrization causes lower eyelid retraction. Sixty-one retracted lower eyelids were surgically repaired without a skin graft in 40 patients. In the new technique, the retracted lower lid is repaired by releasing the lower eyelid retractors from their tarsal attachment. A lateral canthoplasty and lower lid prezygomatic flap anchored to the orbital periosteum support the released lower eyelid.

Computed tomography of Grave's ophthalmopathy diagnosis, management, and posttherapeutic evaluation

Computed tomography (CT) is emphasized in the diagnosis and management of Grave's ophthalmopathy. This report illustrates the value of CT in evaluating the extent of disease, choice and timing of treatment, radiation therapy planning, and posttreatment follow-up of nine patients with Grave's ophthalmopathy. Eight patients had bilateral disease, and three patients had evidence of optic nerve compression. Postirradiation follow-up CT was done in three patients. eight patients treated with radiation obtained good response.

Hyperthyroidism and the impalpable thyroid gland.

A retrospective analysis of 594 unselected cases of hyperthyroidism from one district was made to determine whether the thyroid gland had been palpable on presentation. The thyroid had been diffusely palpable in 374 patients (63%), nodular in 110 (19%) and impalpable in 96 (16%); there was no clinical record in 14 (2%) cases. Under 40 years of age a diffuse gland was usual, being present in 86% of cases. The proportion of nodular and impalpable glands both increased progressively with age comprising 30% and 48% respectively in patients older than 70 years. Grave's ophthalmopathy was present in 13% of hyperthyroid patients with diffuse glands, in 12% of those with impalpable glands, but in only 1.5% of those with nodular thyroids. Thyroid autoantibodies were found with a similar frequency in all three groups. There was a very good correspondence between clinical assessment of shape and nodularity of thyroid and the results of isotope scanning; the majority of patients with impalpable glands (86%) had a diffuse uptake of isotope. In the elderly hyperthyroid patient an impalpable thyroid gland is common and is not a factor to weight against the diagnosis.

Radiation Retinopathy After Orbital Irradiation for Graves' Ophthalmopathy

Recent reports indicate that orbital irradiation for Graves' ophthalmopathy is sometimes beneficial, particularly for dysthyroid optic neuropathy, and is not associated with serious complications. We are aware, however, of four patients who were found to have radiation retinopathy after orbital irradiation for Grave's ophthalmopathy. All four patients have decreased central acuity, and three of the four are legally blind in one or both eyes. Computer reconstruction of the dosimetry, based on computed tomography and beam profiles, shows that errors in dosage calculations and radiotherapy technique probably account for the radiation retinopathy in three of the four patients. Radiotherapy for Graves' ophthalmopathy should be administered only by competent radiotherapists who are experienced in the treatment of this disease. Similar errors in dosage calculations and treatment techniques may account for other reports of radiation retinopathy after reportedly safe dosages.

High-resolution CT of lesions of the optic nerve.

The optic nerves are well demonstrated by high-resolution computed tomography. Involvement of the optic nerve by optic gliomas and optic nerve sheath meningiomas is well known. However, nonneoplastic processes such as increased intracranial pressure, optic neuritis, Grave ophthalmopathy, and orbital pseudotumor may also alter the appearance of the optic nerve/sheath on computed tomography. Certain clinical and computed tomographic features permit distinction of these nonneoplastic tumefactions from tumors.

Neuro-ophthalmology: Symposium of the University of Miami and the Bascom Palmer Eye Institute,

This is the ninth volume in the Neuro-ophthalmology Symposia series, which has been coming out of Miami for the last 13 years. Together, the various volumes make a fascinating record of the progress of the subspecialty. Some topics, such as what to do about amaurosis fugax, the use of steroids in optic neuritis, and Grave's ophthalmopathy, have been chewed and rechewed for more than a decade. But some topics were almost unheard of when the series began (ie, the retinal nerve fiber layer in optic nerve disease; computerized tomography scanning; transsphenoidal microsurgery of the sellar region). Interestingly, 38% of the pages in this book are by ophthalmologists, and 62% are by other specialists (neurologists, neurosurgeons, neuroradiologists, neuropathologists). This suggests that the contents should be particularly instructive to the ophthalmologists who still represent perhaps three quarters of all the neuro-ophthalmologists active today. Like its predecessors, this is an important book,