Extraocular Muscles Research Articles

Evaluation of Inflammatory Activity of Extraocular Muscles in Thyroid Associated Orbitopathy by [68Ga]DOTATATE PET/CT.

The accurate assessment of inflammatory activity of the extraocular muscles (EOMs) in thyroid associated ophthalmopathy (TAO) is crucial for formulating subsequent treatment strategies and prognostic judgments. This study aims to explore the efficacy of using [68Ga]DOTATATE PET/CT to assess the inflammatory activity of EOMs in TAO patients. This study enrolled 22 TAO patients and 6 healthy volunteers, all of whom underwent orbital [68Ga]DOTATATE PET/CT. Among these, 18 patients underwent orbital [99mTc]DTPA SPECT/CT within one week, and the other 4 patients received orbital MRI. All imaging data were independently assessed, followed by comparative data analysis. The patients then received different treatment schemes, and their prognosis was followed up. [68Ga]DOTATATE PET/CT could effectively evaluate the inflammatory activity of the EOMs in TAO patients and demonstrate good consistency with [99mTc]DTPA SPECT/CT and orbital MRI, but show a better resolution to distinguish EOMs and surrounding structure. The receiver operating characteristic (ROC) curves for each EOM, treated as individual research units, exhibited an area under the curve (AUC) exceeding 0.9. The medial rectus demonstrated the highest involvement and diagnostic accuracy(AUC = 0.976, P < 0.001). Patients treated with glucocorticoids showed significantly higher SUVmax in EOMs compared to those receiving symptomatic treatment (P < 0.01). [68Ga]DOTATATE PET/CT is a reliable method for assessing the inflammatory activity of EOMs in TAO patients, providing strong objective evidence for the precise diagnosis and treatment.

Orienting Gaze Toward a Visual Target: Neurophysiological Synthesis with Epistemological Considerations

The appearance of an object triggers an orienting gaze movement toward its location. The movement consists of a rapid rotation of the eyes, the saccade, which is accompanied by a head rotation if the target eccentricity exceeds the oculomotor range and by a slow eye movement if the target moves. Completing a previous report, we explain the numerous points that lead to questioning the validity of a one-to-one correspondence relation between measured physical values of gaze or head orientation and neuronal activity. Comparing the sole kinematic (or dynamic) numerical values with neurophysiological recordings carries the risk of believing that the activity of central neurons directly encodes gaze or head physical orientation rather than mediating changes in extraocular and neck muscle contraction, not to mention possible changes happening elsewhere (in posture, in the autonomous nervous system and more centrally). Rather than reducing mismatches between extrinsic physical parameters (such as position or velocity errors), eye and head movements are behavioral expressions of intrinsic processes that restore a poly-equilibrium, i.e., balances of activities opposing antagonistic visuomotor channels. Past results obtained in cats and monkeys left a treasure of data allowing a synthesis, which illustrates the formidable complexity underlying the small changes in the orientations of the eyes and head. The aim of this synthesis is to serve as a new guide for further investigations or for comparison with other species.

TOM500: A Multi-Organ Annotated Orbital MRI Dataset for Thyroid Eye Disease

This study presents TOM500, a comprehensive multi-organ annotated orbital magnetic resonance imaging (MRI) dataset. It includes clinical data, T2-weighted MRI scans, and corresponding segmentations from 500 patients with thyroid eye disease (TED) during their initial visit. TED is a common autoimmune disorder with distinct orbital MRI features. Segmentations of nine orbital structures, including the optic nerve, orbital fat, lacrimal gland, eyeball, and five extraocular muscles (superior rectus and levator palpebrae superioris complex, inferior rectus, medial rectus, lateral rectus, and superior oblique), were generated by three junior annotators and reviewed by an expert radiologist. The consistency of the segmentations was evaluated using the intraclass correlation coefficient. Clinical data, including sex, age, disease duration, and smoking status, are also provided for disease diagnosis and classification. TOM500, the largest publicly available orbital MRI dataset with expert annotations, is designed to facilitate the development of advanced computational tools for TED diagnosis, classification, and observation.

Low clinical activity score, ‘progressive’ thyroid eye disease: presentations of 1439 patients from a tertiary centre in Hong Kong

BackgroundTo report the presenting clinical, serological and treatment profiles of 1439 patients with thyroid eye disease (TED) from a tertiary centre in Hong Kong.Study populationsConsecutive patients with TED presented to...

Ravulizumab (Ultomiris)

Canada’s Drug Agency (CDA-AMC) recommends that Ultomiris be reimbursed by public drug plans for the treatment of adults with generalized myasthenia gravis (gMG) if certain conditions are met. Ultomiris should only be covered to treat those who meet the Myasthenia Gravis Foundation of America (MGFA) classification (which categorizes clinical features by increasing severity) of II (i.e., mild weakness affecting body muscles and may also include weakness in the eye muscles) to IV (i.e., severe weakness affecting body muscles and may also include weakness in the eye muscles), test positive for anti–acetylcholine receptor (AChR) antibodies, and have a Myasthenia Gravis Activities of Daily Living (MG-ADL) score (which estimates patients’ ability to perform activities of daily living) of at least 6 (scores range from 0 to 24, with higher scores indicating more impairment). Ultomiris should only be covered to treat patients if their symptoms persist despite a stable dose of standard of care acetylcholinesterase inhibitors (AChEIs), corticosteroids (CSs), and/or nonsteroidal immunosuppressants (NSISTs). Ultomiris should only be covered to treat those who have received prior vaccination against meningococcal infections. Ultomiris should not be reimbursed when given during a gMG exacerbation (i.e., a moment when the patient experiences weakness in some or all muscles, without needing assistance to breath) or crisis (i.e., a moment when respiratory muscles are too weak, limiting air flow in and out of lungs, and as a result the patient is unable to breathe), or within 12 months of thymectomy (i.e., surgical removal of thymus gland). Ultomiris should only be reimbursed if prescribed by or in consultation with a neurologist with expertise in managing patients with gMG and the cost of Ultomiris is reduced. Ultomiris should not be used concomitantly with rituximab, efgartigimod alfa, or complement inhibitors, such as eculizumab.

Effect of induced extrinsic and intrinsic hand and forearm muscular fatigue on the control of finger force during piano playing.

This study aimed to investigate the effect of hand muscle fatigue on finger control and force efficiency during piano performance, which is crucial for skilled piano playing among professional pianists engaged in prolonged periods of high-intensity practice or concert preparation. Thirty-one professional pianists were recruited as participants. This study was divided into three sequential experimental parts: pre-fatigue test, fatigue protocol, and post-fatigue test. Each participant was assigned eight piano skills and instructed to perform two fatigue tasks: finger extension and finger grasping exercises. The study recorded and analyzed the finger force of professional pianists using a sensor-embedded kinetic assessment piano system; wrist movements were assessed using a three-dimensional motion capture system. Paired t-tests were used to determine the differences between the pre- and post-tests. The findings showed that the average peak striking force of most fingers in Chords 1, 2, 4, 5, 6, and 7 decreased significantly after the fatigue task, indicating a reduction in the finger-striking force following fatigue across the various chord fingerings. The analysis of wrist movements demonstrated strategic adjustments made by pianists after experiencing fatigue, particularly in the ulnar/radial deviation movements. This study highlights the influence of muscle fatigue on finger control and wrist movements of pianists across different fingerings. We recommend that pianists focus on strengthening the extrinsic and intrinsic muscles of the hand and the muscle groups responsible for controlling ulnar/radial movements to mitigate the effects of muscular fatigue on hand performance.

Astigmatism in Duane Retraction Syndrome

PurposeTo compare the prevalence, magnitude, and type of astigmatism among patients with different Duane Retraction Syndrome (DRS) types.MethodThis retrospective cross-sectional study reviewed the records of 312 DRS patients. Patients were categorized into DRS Types 1, 2, 3, and bilateral cases. Refractive errors and visual acuity were analyzed, emphasizing the prevalence of astigmatism types, specifically with-the-rule (WTR), against-the-rule (ATR), and oblique, as well as the power vectors for each DRS subtype.ResultsOur study included 312 patients with DRS, comprising 44.6% males and a median age of 18.5 years (interquartile range [IQR]: 7–27). Of these, 280 had unilateral DRS and 32 had bilateral DRS. The median age for unilateral DRS patients was 19 years (IQR: 7–27; 43.2% males), whereas for bilateral DRS patients, it was 16 years (IQR: 6-29.2; 56.3% males). In all DRS patients, 180 (57.7%) were diagnosed with Type 1 DRS, 87 (27.9%) with Type 2 DRS, and 45 (14.4%) with Type 3 DRS. In unilateral cases, WTR astigmatism was the most prevalent (56.8%), followed by oblique (23.6%) and ATR astigmatism (19.6%). Bilateral DRS patients exhibited a similar distribution in both eyes, with WTR astigmatism also being predominant. The comparative analysis of power vectors indicated that Type 1 DRS exhibited a greater prevalence of WTR and oblique astigmatism, whereas ATR astigmatism was the predominant pattern in Types 2 and 3. A comparison of cylindrical powers and power vectors among fellow eyes of different DRS subtypes revealed that Type 2 DRS had significantly higher cylindrical power (p = 0.017) and a greater tendency toward ATR astigmatism (p = 0.038) than fellow eyes in other subtypes, suggesting that astigmatic changes may also occur in fellow eyes.ConclusionOur study demonstrates a high prevalence of astigmatism, particularly WTR astigmatism, in DRS patients. Furthermore, we found significant associations between specific astigmatism patterns and DRS subtypes, suggesting a potential link between extraocular muscle innervation, co-contraction, and corneal shape. These findings highlight the importance of comprehensive astigmatism assessment in DRS patients for optimal refractive management.

Adult and pediatric orbital rhabdomyosarcoma: comparison of characteristics and outcomes

ABSTRACT Introduction Rhabdomyosarcoma (RMS) is a common pediatric orbital malignancy but is extremely rare in adults. This study assesses clinical and radiographic features, management, and outcomes in adult orbital RMS patients with comparison to pediatric patients. Methods A retrospective chart review from 2000–2023 at Bascom Palmer Eye Institute was conducted evaluating patients aged 0 to 100-years-old with biopsy-confirmed orbital RMS. Medical records were reviewed for demographics, clinical features, imaging, histopathology, management, and outcomes. Statistical analysis was conducted with Mann-U Whitney and chi-squared testing. Results Twenty-four patients were included, 15 children (mean age 6.4 ± 4.4 years) and 9 adults (35.7 ± 12.4 years). Patients in both groups presented with eyelid edema followed by proptosis with similar symptom duration (p = 0.31). Lesions were frequently located medially and inferiorly in both groups. At presentation, adults had significantly more metastatic disease in addition to bone, extraocular muscle, intracranial, and parameningeal involvement. The most common pediatric RMS subtype was embryonal (80%), whereas most adults were alveolar (77.8%, p = 0.001). Treatment in both groups frequently included chemoradiation. Both groups demonstrated similar local recurrence (p = 0.72), overall survival (p = 0.86), and ophthalmologic sequelae (p = 0.45), although pediatric follow-up duration was notably longer. Conclusions To our knowledge, this study is the largest report of adult orbital RMS from a single institution, highlights key comparisons in features and outcomes between adult and pediatric orbital RMS, and provides an updated literature review. While pediatric and adult orbital RMS clinical presentations are similar, adult disease more often demonstrates aggressive features, including alveolar subtype, local structure involvement, and lower disease-free survival.

Proteomic analysis and biomarker discovery of water holding capacity differences in bighead carp eye and dorsal muscles during frozen storage

Differentially abundant proteins (DAPs) in the eye muscle (EM) and dorsal muscle (DM) of bighead carp were compared at the initial state (-0) and after six months of frozen storage (-6) using proteomics. The WHC of EM and DM decreased by 21.08% and 12.79% after 6 months of frozen storage. Further comparative proteomic analysis revealed that a total of 20, 21, 78 and 58 DAPs were identified and focused in DM-6 vs. DM-0, EM-6 vs. EM-0, EM-0 vs. DM-0 and EM-6 vs. DM-6, respectively. Additionally, in DM-6 vs. DM-0, up-regulated DAPs involved myosin isoforms, actinin, and iron metabolism, while down-regulated DAPs involved myosin isoforms, actin, lactate synthesis, and protein degradation. In EM-6 vs. EM-0, up-regulated DAPs involved myosin isoforms, and down-regulated DAPs involved myosin isoforms, actin, glycolysis, and protein degradation. DAPs function analysis indicated that EM showed better MP repair, antioxidation, aerobic metabolism, and protein degradation but inferior glycolytic metabolism compared to DM. Tubulin beta chain could serve as a biomarker to reflect the extent of freezing in bighead carp muscle. Malate dehydrogenase had the potential to evaluate WHC difference between EM and DM. These results offer insights into the causes of WHC differences between EM and DM in bighead carp, providing a theoretical foundation for optimizing fish processing and tailoring storage in the industry.

Effects of strabismus surgery on cornea

Background Strabismus is a common disorder that is mostly treated surgically. Extraocular muscle surgery may induce refractive and corneal topographic changes. Aim To study the effect of horizontal strabismus surgery on corneal topography Patients and methods This prospective interventional randomized study was carried out on 20 patients aged from 5 to 30 years old diagnosed with horizontal strabismus who did not undergo any ocular surgery before. They were divided into four groups. We did lateral rectus recession in the first group, lateral rectus resection in the second group, medial rectus resection in the third group, and medial rectus recession in the fourth one. We compared the spherical equivalent and the corneal topographic parameters (K1, K2, the power and the axis of the astigmatism) preoperative, at 1 month postoperative, and at 6 month postoperative. Results There was myopic shift in the spherical equivalent in all groups and it was more significant after recession surgery. There was a statistically significant change in K1, K2, and astigmatism power after recession of medial and lateral recti muscles which persisted till the postoperative sixth month. The change after resection of medial and lateral recti muscles was insignificant. The change in the axis was insignificant in all groups. Conclusions Recession surgery of medial or lateral recti has more effect on refraction and corneal topography than resection. Horizontal strabismus surgeries induce a significant myopic shift in the spherical equivalent and do not induce a significant change in the axis.

Differential effects of intrinsic- versus extrinsic-first corrective exercise programs on morphometric outcomes and navicular drop in pediatric flatfoot

Although the connection between muscular strength and flatfoot condition is well-established, the impact of corrective exercises on these muscles remains inadequately explored. This study aimed to assess the impact of intrinsic- versus extrinsic-first corrective exercise programs on muscle morphometry and navicular drop in boys with flexible flatfoot. Twenty-five boys aged 10–12 with flexible flatfoot participated, undergoing a 12-week corrective exercise program, with a shift in focus at six weeks. Ultrasound imaging measured muscle thickness and cross-sectional area (CSA), and the navicular drop test assessed flatfoot severity. The results demonstrated a significant interaction between exercise type and sequencing on muscle morphometry. Initiating with intrinsic exercises led to sustained improvement, even after transitioning to extrinsic exercises, while extrinsic-first exercises caused deterioration in intrinsic muscle morphometry, which was recovered after transitioning to intrinsic exercises. Statistical analysis revealed significant improvements in muscle thickness and CSA over time, particularly when initiating intrinsic exercises first. The intrinsic-first group also exhibited a more pronounced reduction in navicular drop. In conclusion, initiating corrective exercises with intrinsic muscles proved more effective in improving foot muscle morphometry and reducing navicular drop in boys with flatfoot. Therefore, commencing correction with intrinsic muscle exercises is recommended before progressing to extrinsic muscle exercises.

Application of apparent diffusion coefficient of extraocular muscles from diffusion tensor imaging scanning in the assessment of disease activity of thyroid eye disease

Application of apparent diffusion coefficient of extraocular muscles from diffusion tensor imaging scanning in the assessment of disease activity of thyroid eye disease

Clinical and Radiologic Predictors of Response to Teprotumumab: A 3D Volumetric Analysis of 35 Patients.

Teprotumumab, a novel human monoclonal antibody, has been shown to reverse the clinical manifestations of thyroid eye disease. Previous reports have suggested that it demonstrates disease-modifying properties through the reduction of orbital fat and muscle volumes. This study aims to analyze orbital volumetric change following treatment and to identify clinical and radiological predictors of response. This was a prospective longitudinal study with 35 consecutive patients who had available pre- and posttreatment orbital imaging. Three-dimensional volumetric calculations of orbital fat, extraocular muscles, and proptosis were measured using previously validated image processing software. This information was used with demographic data to create a multivariate regression model to review which baseline clinical or radiological factors were predictors of proptosis response. In the study orbit, 20 patients (57%) had a proptosis reduction of ≥2 mm. In the fellow orbit, 18 patients (51%) had a proptosis reduction of ≥2 mm. Regression modeling revealed that baseline proptosis and baseline muscle volumes were significant predictors of proptosis response (p < 0.01 and p < 0.05, respectively). Further, changes in muscle volume and fat volume were significantly associated with proptosis response (r = 0.5, p < 0.001 and r = 0.3, p = 0.012, respectively). Teprotumumab significantly reduces orbital fat and muscle volumes. This is manifested by a significant reduction in proptosis. Baseline proptosis and muscle volumes are significant predictors of proptosis response.

Effects on Posture of a Two-Diopter Horizontal Prism Base Out on the Non-Dominant Eye.

Background/Objectives: Ocular proprioception is implicated in balance control and heterophoria is associated with abnormal posture, though previous research focused mainly on the role of vertical phoria and the use of vertical prisms. This study aims to evaluate whether ocular misalignment and prismatic correction of horizontal phoria affect posture. Methods: Sixty-nine (N = 69) young healthy subjects were included and equally divided by horizontal distance phoria: orthophoria (n = 23), esophoria (n = 23) and exophoria (n = 23). A prism of low power (two-diopter) was placed base out on the non-dominant eye, reducing misalignment in esophorics and increasing it in exophorics more than in orthophorics. Dynamic computerized posturography was performed with the sensory organization test protocol (SOT) of the EquiTest® NeuroCom® version 8 platform both without and with prism, always maintaining subjects unaware of prism use. A mixed model for repeated measures analysis of variance was run to evaluate the main effect of prism and the interaction effect of prism with baseline phoria. Results: Composite movement strategy score without prism was 88.1 ± 2.8% (ankle-dominant strategy) and slightly increased to 89.0 ± 3.1% with prism insertion (p = 0.004), further shifting toward ankle strategy. Composite equilibrium score without prism was 80.3 ± 6.5% and remained stable with prism insertion (81.3 ± 8.2%, p = 0.117), medio-lateral and antero-posterior projection of center of gravity did not displace significantly under prism insertion (p = 0.652 and p = 0.270, respectively). At baseline, posturographic parameters were statistically independent of individual phoria, and no significant interaction between prism insertion and individual phoria was documented for any parameters (p > 0.05 for all). Secondary analysis and pairwise comparisons confirmed that the effect of prism was strongly selective on condition SOT 5 (eyes-closed, platform sway-referenced) with improvement of equilibrium (70.4 ± 9.7% with prism vs. 65.7 ± 11.6% without) and more use of ankle strategy (81.6 ± 5.3% with prism vs. 78.2 ± 6.0% without), without any interaction of phoria and ocular dominance, while the other conditions were comparable with and without prism. Conclusions: A two-diopter prism base out on the non-dominant eye induces the body to use the ankle joint more independently of individual phoria, suggesting a small improvement in postural control, while maintaining oscillations of the center of gravity unaltered. Prism seems to enhance the function of vestibular system selectively. Phoria adjustments with prismatic correction enable intervention in postural behavior. Extraocular muscles could act as proprioceptors influencing postural stability.

Organic trace elements enhance growth performance, antioxidant capacity, and gut microbiota in finishing pigs

Excessive inorganic trace elements are added to livestock and poultry feed to meet the needs of animals, accompanied by frequent occurrence of excretion and gastrointestinal stress. Replacing inorganic trace elements with organic trace elements provides a promising solution to alleviate these problems. Therefore, this study aimed to assess the impact of replacing all inorganic trace elements (ITMs) in feed on the growth performance, meat quality, serum parameters, trace element metabolism, and gut microbiota of finishing pigs. A total of 128 Duroc × Landrace × Yorkshire growing-finishing pigs (33.88 ± 0.62 kg) were assigned to four treatments in a randomized complete block design. Each treatment was divided into four replicates, each containing eight pigs. The control group received a basal diet containing 100% inorganic trace elements, while the experimental groups were provided with diets where all inorganic trace elements were substituted with 30, 50, and 70% organic trace elements. The experiment spanned 56 days. Results indicated that replacing all ITMs with 30, 50, and 70% OTMs demonstrated no adverse effects on average daily feed intake, average daily gain, feed conversion ratio, eye muscle area, backfat thickness, and relative organ weight of finishing pigs compared to the control group. Furthermore, the replacement led to increased serum immunoglobulin A concentration and Cu-SOD enzyme activity, and decreased serum MDA level, and GSH-Px activity in the liver. Notably, 50 and 70% OTMs increased serum Mn-SOD activity, and 70% OTMs increased serum T-AOC content. Moreover, it significantly decreased the excretion of trace elements in feces without compromising their deposition in the muscle. Additionally, replacing 100% ITMs with 30% OTMs resulted in an improved Shannon index of colonic microbiota in finishing pigs. In conclusion, replacing 100% inorganic trace elements with 30, 50, and 70% organic trace elements exhibited no detrimental effects on the performance of finishing pigs. In conclusion, replacing 100% inorganic trace elements with 70% organic trace elements had certain potential to improve the production performance of finishing pigs. This replacement strategy can enhance meat quality, boost antioxidant capacity, reduce trace element excretion, facilitate trace element absorption and deposition, and enhance gut microbiota homeostasis.

Patterns of Extraocular Muscle Enlargement in Graves' Orbitopathy and Acromegaly.

Purpose: Extraocular muscle (EOM) enlargement occurs in both acromegaly and Graves' disease, but the degree and pattern of enlargement have not been directly compared in these patient groups. This study investigated whether acromegaly and Graves' orbitopathy (GO) are associated with different patterns of EOM enlargement at the time of diagnosis. Study Design: Retrospective cohort. Methods: All new patients with a diagnosis of acromegaly or GO who presented to St Joseph's Health Care in London, Ontario, between January 1, 2015, and July 1, 2020, and who underwent computed tomography (CT) scanning with adequate orbital imaging were considered for inclusion. We included age- and sex-matched control patients with pituitary macroadenomas without thyroid or growth hormone abnormalities. Orbital CT scans were analyzed by a single neuroradiologist, who measured the maximum diameter and cross-sectional area of each EOM. The relative likelihood of involvement of each rectus EOM was analyzed separately using an analysis of variance test. Results: We included 16 patients with GO, 17 with acromegaly, and 18 controls. Ages (mean ± standard deviation) of groups were 55.6 ± 18.0, 50.2 ± 15.7, and 49.3 ± 14.0 years. The mean maximum diameter of EOMs in GO, acromegaly, and controls was inferior rectus (IR) = 4.77 ± 1.53, 4.66 ± 0.61, and 3.68 ± 0.61 mm; medial rectus (MR) = 5.35 ± 2.23, 4.84 ± 0.81, and 3.65 ± 0.42 mm; superior rectus (SR) = 4.94 ± 1.84, 4.88 ± 0.91, and 3.68 ± 0.61 mm; and lateral rectus (LR) = 3.91 ± 1.59, 4.55 ± 0.60, and 3.20 ± 0.43 mm. The IR, MR, and SR muscles were significantly larger in the GO group compared with controls (IR, p = 0.020; SR, p = 0.004; MR, p < 0.001; and LR, p = 0.166), and all four EOMs were larger in acromegaly compared with controls (IR, p = 0.039; SR, p = 0.006; MR, p = 0.006; and LR, p = 0.001). There was no significant difference between the GO and acromegaly groups (IR, p = 0.959; SR, p = 0.987; MR, p = 0.408; and LR, p = 0.250). Conclusions: GO and acromegaly groups demonstrated the enlargement of the IR, MR, and SR muscles when compared with controls. The GO group did not show significantly larger EOM sizes compared with the acromegaly group. In the GO group, the IR, MR, and SR were similarly affected and did not follow previously described patterns of enlargement in GO.

Botulinum Toxin Treatment in Thyroid Eye Disease: A Systematic Review and Meta-analysis.

Thyroid eye disease-related retraction and strabismus treatment is complicated by the activity level of the disease. Botulinum toxin injection can provide relief of symptoms in lieu of, or while waiting for surgery, radiation, or alternative medications. This study reviews techniques, outcomes, and effectiveness of botulinum toxin usage in thyroid eye disease. A systematic review was conducted using PubMed, Embase, Web of Science, and Cochrane to identify research investigating botulinum toxin treatment of thyroid eye disease through May 2024. A meta-analysis was performed on change in marginal reflex distance in retraction patients, resolution of diplopia in strabismus patients, necessity of further strabismus surgery, and side effects. Of 157 studies screened by 2 reviewers, 30 underwent analysis. In 19 upper eyelid retraction studies (299 patients), 1.5 to 15 U Botox (onabotulinum toxin A) or 10 to 40 U Dysport (abobotulinum toxin A) was administered to the superior tarsal border, with an 84% success rate and an average decrease in marginal reflex distance of 2.42 mm lasting 1 to 6 months. In 10 strabismus studies (205 patients), 5 to 20 U Botox or 25 U Dysport was administered in extraocular muscles; 24% achieved resolution of diplopia lasting 2 to 6 months, while 58% required further surgical management. In upper eyelid retraction studies, side effects included ptosis (13%) and diplopia (2%). In strabismus studies, side effects included ptosis (2%). This systematic review and meta-analysis confirmed that botulinum toxin is an effective treatment for thyroid eye disease-related lid retraction and strabismus. Randomized controlled studies are warranted to optimize botulinum toxin administration.

Monocyte to high-density lipoprotein cholesterol ratio as a predictor of the activity of thyroid-associated ophthalmopathy.

To evaluate the relationship between monocyte to high-density lipoprotein cholesterol ratio (MHR) and the disease activity of thyroid-associated ophthalmopathy (TAO). A total of 87 patients were classified into two groups based on clinical activity score (CAS) scoring criteria: high CAS group (n=62, the CAS score was ≥3); low CAS group (n=25, the CAS score was <3). In addition, a group of healthy people (n=114) were included to compared the MHR. Proptosis, MHR, average signal intensity ratio (SIR), average lacrimal gland (LG)-SIR, average extraocular muscles (EOM) area from 87 patients with TAO were calculated in magnetic resonance imaging (MRI), and compared between these two groups. Correlation testing was utilized to evaluate the association of parameters among the clinical variables. Patients in high CAS group had a higher proptosis (P=0.041) and MHR (P=0.048). Compared to the healthy group, the MHR in the TAO group was higher (P=0.001). Correlation testing declared that CAS score was strongly associated with proptosis and average SIR, and MHR was positively associated with CAS score, average SIR, and average LG-SIR. The area under the receiver operating characteristic curve (AUC) of MHR was 0.6755. MHR, a novel inflammatory biomarker, has a significant association with CAS score and MRI imaging (average SIR and LG-SIR) and it can be a new promising predictor during the active phase of TAO.

The value of signal intensity ratios of orbital tissue to white matter of orbital MRI in evaluating graves' orbitopathy.

PURPOSE: To investigate the signal intensity ratio (SIR) of orbital tissue to white matter in orbital magnetic resonance imaging (MRI) for assessing graves' orbitopathy (GO). This study enrolled a total of 42 patients (79 eyes) with GO as the GO group, 10 patients (20 eyes) diagnosed with graves' disease (GD) without orbitopathy during the same period as the GD group, and 23 normal individuals with negative MRI results and no thyroid or eye diseases as the healthy control (HC) group. The signal intensity of the lacrimal gland (LG), extraocular muscle (EOM), ipsilateral temporal muscle (TM), ramus mandibulae, and white matter (WM) on MRI images was measured. Patients in the GO group were categorized into active and inactive GO subgroups. The SIRs in the GO, GD, and HC groups showed significant differences. SIR-LG in relation to WM and SIR-EOMs in the GO group were significantly higher than those in the GD and HC groups. The SIRs in the active GO group were higher than those in the inactive GO group with significant differences, except for SIR-LG/TM. SIR-EOM/WM demonstrated higher accuracy than other SIRs in identifying GO activity. The area under the curve for SIR-EOM/WM was 0.81 (95% CI 0.71-0.91), with a sensitivity of 69.6%, specificity of 87.9%, and a cut-off value of 1.50. SIR-LG/WM and SIR-EOMs are objective indicators for discriminating between GO and the other two groups. Furthermore, SIR-EOM/WM may serve as a simpler quantitative MRI biomarker for identifying GO activity and are worthy of clinical generalization.

The Relevance and Potential Role of Orbital Fat in Inflammatory Orbital Diseases: Implications for Diagnosis and Treatment.

The orbit is an important structure within the skull that houses the eye, optic nerve, and extraocular muscles. It also contains adipose/fat tissue, which provides a protective cushion for these components. Inflammatory orbital disease can affect any or all components of the orbit, often arising from various underlying pathologic conditions, including autoimmune, infectious, and vascular diseases. Typical signs and symptoms of orbital inflammation include swelling, redness, pain, discomfort, and potential loss of function. The role of orbital fat in the pathogenesis of inflammatory orbital diseases has not been fully explored. This review aims to provide a comprehensive description of orbital fat, its relevance and the potential role in inflammatory diseases of the orbit, and the use of radiologic imaging studies for evaluating this fat depot in cases of as inflammatory orbital diseases. Additionally, this review discusses the various procedures available for the treatment and management of these conditions. A range of interventions, including pharmacotherapy and surgical procedures, will be evaluated as promising therapeutic options. This review also explores the characteristics and potential applications of orbital fat-derived stem cells, with an emphasis on their regenerative abilities and anti-inflammatory effects. Understanding the role of orbital fat and its contribution to inflammatory orbital diseases is essential for optimizing diagnostic and treatment strategies.