Hemangiomas in infancy generally require a multidisciplinary approach. As a result of their natur... more Hemangiomas in infancy generally require a multidisciplinary approach. As a result of their natural course, usually with spontaneous involution, a “watch-and-wait” strategy often seems to be sufficient. Nevertheless, in periorbital hemangiomas not only cosmetic but also functional aspects may require an early intervention. There are many treatment options such as steroids, surgery, cryotherapy, magnesium seeds and laser. The present paper
To compare the outcome of various surgical approaches of orbital decompression in patients with G... more To compare the outcome of various surgical approaches of orbital decompression in patients with Graves' orbitopathy (GO) receiving surgery for disfiguring proptosis. Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed. Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 (SD 2.1) mm. After three-wall decompression the proptosis reduction was significantly greater than after two-wall decompression. Additional fat removal resulted in greater proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life (QOL) in the appearance arm of the GO-QOL questionnaire was 20.5 (SD 24.8) points. In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The extent of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but was rare in this series after the swinging eyelid approach.
Glucocorticoids are effective for severe Graves' orbitopathy (GO), which ... more Glucocorticoids are effective for severe Graves' orbitopathy (GO), which causes substantial morbidity. The question at issue is how best to use them. The objective of this study was to optimize glucocorticoid application in GO. The study design was a randomized trial over 12 wk with 6-month follow-up. The study was performed at university joint thyroid and ophthalmic clinics. Seventy euthyroid out-patients with untreated, active, and severe GO were studied. Patients received either once weekly iv methylprednisolone (0.5 g, then 0.25 g, 6 wk each) or oral prednisolone starting with 0.1 g/d, then tapering the dose by 0.01 g/wk. At 3 months, the primary end point was a composite of improvements in proptosis, lid fissure width, and rate of diplopia in primary gaze, visual acuity, eye muscle thickness, and patient's quality of life. Intravenous glucocorticoid therapy resulted in rapid, significant, and sustained improvement. At 3 months, 27 of 35 patients (77%) in the iv group had a treatment response compared with 18 of 35 (51%) in the oral group (P < 0.01). Improvements over baseline values for disease severity (e.g. visual acuity; P = 0.01) and activity (e.g. chemosis; P < 0.01) and for quality of life (P < 0.001) were greater in the iv group. TSH receptor antibody titers decreased during iv steroid administration (P < 0.001), and smoking had a strong impact on the therapy response (P < 0.001). Additional treatment was required less frequently in the iv group. Intravenous steroids were safe, with different rates of adverse events between the two groups (P < 0.001). In patients with active and severe GO, iv glucocorticoids were more effective and better tolerated than oral steroids.
PURPOSE. To determine the presence of activated complement components in eyes affected by diabeti... more PURPOSE. To determine the presence of activated complement components in eyes affected by diabetic retinopathy. METHODS. Eyes of 50 deceased donors with diabetic retinopa- thy and of 10 nondiabetic subjects with uveal melanoma (n 6) or phthisical eyes (n 4), as well as eyes of 16 deceased donors without diabetic retinopathy were subjected to immu- nohistochemical studies, using a panel
Orbital radiotherapy (Rx) is a commonly used treatment for Graves' ophthalmopathy (GO), but c... more Orbital radiotherapy (Rx) is a commonly used treatment for Graves' ophthalmopathy (GO), but controlled clinical trials evaluat- ing different Rx doses and application forms have not been performed. In euthyroid patients with moderately severe GO, we randomly com- pared the efficacy and tolerability of three Rx protocols. Orbital Rx (telecobalt) was administered either in 20 divided fractions of 1 Gray
Investigative ophthalmology & visual science, Jan 31, 2015
In patients with thyroid-associated orbitopathy (TAO), the dry eye syndrome occurs frequently, an... more In patients with thyroid-associated orbitopathy (TAO), the dry eye syndrome occurs frequently, and symptoms and signs of both disorders overlap making early and accurate differential diagnosis difficult. A differentiation via specific markers is warranted. Tear fluid samples of 120 subjects with TAO, TAO+dry eye, dry eye and controls were collected. The samples were measured using matrix assisted laser desorption ionisation mass spectrometry. The identified proteins where tested with antibody microarrays. Proteomics identified deregulated proteins in TAO and dry eye. Compared to dry eye, Proline-rich-protein 1 (PROL1, p=0.002), UDP-glucose-dehydrogenase (UGDH, p=0.017), Calgranulin A (S10A8, p<0.0001), Transcription-activator BRG1 (SMCA4, p<0.0001), Annexin A1 (p=0.007), Cystatin (p=0.009), Heat shock protein 27 (p=0.03), and Galectin (p=0.04), were markedly down-regulated in TAO. Compared to healthy controls, PROL1 (p<0.05.), Proline-rich protein 4 (PRP4, p<0.05), S10A8...
The removal of excessive melanin pigments that obscure ocular tissue morphology is important to a... more The removal of excessive melanin pigments that obscure ocular tissue morphology is important to address scientific questions and for differential diagnosis of ocular tumours based on histology. Thus, the goal of the present study was to establish an effective and fast melanin bleaching method for paraffin and frozen mouse and human ocular tissues. Paraffin-embedded and frozen ocular specimens from mice and human donors were subjected to bleaching employing two methods. The first employed potassium permanganate (KMnO4) with oxalic acid, and the second 10% hydrogen peroxide (H2O2). To determine optimal bleaching conditions, depigmentation was carried out at various incubation times. The effect of diluents used for 10% H2O2 was assessed using phosphate-buffered saline (PBS), and deionized water. Three different slide types and two fixatives, which were ice-cold acetone with 80% methanol, and 4% paraformaldehyde (PFA) were used to determine the optimal conditions for better tissue adher...
Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, th... more Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, though established since almost one century, is subject of scientific debate. The present study investigated the effect of retrobulbar irradiation using a standardized protocol focussing on long term results. Between 1981 and 1997, 104 patients treated by retrobulbar irradiation (10 to 20 Gray) due to Graves' disease. Twenty-nine of these underwent irradiation as sole treatment (mean follow-up 57 months), while in the remaining 75, it was combined with a systemic steroid treatment (mean follow-up 40 months). Patients were evaluated regarding proptosis, intraocular pressure, lid signs, motility as well as subjective assessment of double vision and retrobulbar pain. While proptosis remained unchanged, lid signs, chemosis and intraocular pressure showed slight and statistically significant improvement. However, these findings were considered to be clinically insignificant. Retrobulbar pai...
International Journal of Radiation Oncology Biology Physics, 2002
Purpose: To evaluate the effectiveness of stereotactic fractionated radiotherapy (SFRT) in the tr... more Purpose: To evaluate the effectiveness of stereotactic fractionated radiotherapy (SFRT) in the treatment of optic nerve sheath meningioma (ONSM).Methods and Materials: Between 1994 and 2000, a total of 39 patients with either primary (n = 15) or secondary (n = 24) ONSM were treated with SFRT and received a median total tumor dose of 54 Gy using 1.8 Gy/fraction.Results: The
Hemangiomas in infancy generally require a multidisciplinary approach. As a result of their natur... more Hemangiomas in infancy generally require a multidisciplinary approach. As a result of their natural course, usually with spontaneous involution, a “watch-and-wait” strategy often seems to be sufficient. Nevertheless, in periorbital hemangiomas not only cosmetic but also functional aspects may require an early intervention. There are many treatment options such as steroids, surgery, cryotherapy, magnesium seeds and laser. The present paper
To compare the outcome of various surgical approaches of orbital decompression in patients with G... more To compare the outcome of various surgical approaches of orbital decompression in patients with Graves&#39; orbitopathy (GO) receiving surgery for disfiguring proptosis. Data forms and questionnaires from consecutive, euthyroid patients with inactive GO who had undergone orbital decompression for disfiguring proptosis in 11 European centres were analysed. Eighteen different (combinations of) approaches were used, the swinging eyelid approach being the most popular followed by the coronal and transconjunctival approaches. The average proptosis reduction for all decompressions was 5.0 (SD 2.1) mm. After three-wall decompression the proptosis reduction was significantly greater than after two-wall decompression. Additional fat removal resulted in greater proptosis reduction. Complications were rare, the most frequent being worsening of motility, occurring more frequently after coronal decompression. The average change in quality of life (QOL) in the appearance arm of the GO-QOL questionnaire was 20.5 (SD 24.8) points. In Europe, a wide range of surgical approaches is used to reduce disfiguring proptosis in patients with GO. The extent of proptosis reduction depends on the number of walls removed and whether or not fat is removed. Serious complications are infrequent. Worsening of ocular motility is still a major complication, but was rare in this series after the swinging eyelid approach.
Glucocorticoids are effective for severe Graves&amp;amp;amp;amp;#39; orbitopathy (GO), which ... more Glucocorticoids are effective for severe Graves&amp;amp;amp;amp;#39; orbitopathy (GO), which causes substantial morbidity. The question at issue is how best to use them. The objective of this study was to optimize glucocorticoid application in GO. The study design was a randomized trial over 12 wk with 6-month follow-up. The study was performed at university joint thyroid and ophthalmic clinics. Seventy euthyroid out-patients with untreated, active, and severe GO were studied. Patients received either once weekly iv methylprednisolone (0.5 g, then 0.25 g, 6 wk each) or oral prednisolone starting with 0.1 g/d, then tapering the dose by 0.01 g/wk. At 3 months, the primary end point was a composite of improvements in proptosis, lid fissure width, and rate of diplopia in primary gaze, visual acuity, eye muscle thickness, and patient&amp;amp;amp;amp;#39;s quality of life. Intravenous glucocorticoid therapy resulted in rapid, significant, and sustained improvement. At 3 months, 27 of 35 patients (77%) in the iv group had a treatment response compared with 18 of 35 (51%) in the oral group (P &amp;amp;amp;amp;lt; 0.01). Improvements over baseline values for disease severity (e.g. visual acuity; P = 0.01) and activity (e.g. chemosis; P &amp;amp;amp;amp;lt; 0.01) and for quality of life (P &amp;amp;amp;amp;lt; 0.001) were greater in the iv group. TSH receptor antibody titers decreased during iv steroid administration (P &amp;amp;amp;amp;lt; 0.001), and smoking had a strong impact on the therapy response (P &amp;amp;amp;amp;lt; 0.001). Additional treatment was required less frequently in the iv group. Intravenous steroids were safe, with different rates of adverse events between the two groups (P &amp;amp;amp;amp;lt; 0.001). In patients with active and severe GO, iv glucocorticoids were more effective and better tolerated than oral steroids.
PURPOSE. To determine the presence of activated complement components in eyes affected by diabeti... more PURPOSE. To determine the presence of activated complement components in eyes affected by diabetic retinopathy. METHODS. Eyes of 50 deceased donors with diabetic retinopa- thy and of 10 nondiabetic subjects with uveal melanoma (n 6) or phthisical eyes (n 4), as well as eyes of 16 deceased donors without diabetic retinopathy were subjected to immu- nohistochemical studies, using a panel
Orbital radiotherapy (Rx) is a commonly used treatment for Graves' ophthalmopathy (GO), but c... more Orbital radiotherapy (Rx) is a commonly used treatment for Graves' ophthalmopathy (GO), but controlled clinical trials evaluat- ing different Rx doses and application forms have not been performed. In euthyroid patients with moderately severe GO, we randomly com- pared the efficacy and tolerability of three Rx protocols. Orbital Rx (telecobalt) was administered either in 20 divided fractions of 1 Gray
Investigative ophthalmology & visual science, Jan 31, 2015
In patients with thyroid-associated orbitopathy (TAO), the dry eye syndrome occurs frequently, an... more In patients with thyroid-associated orbitopathy (TAO), the dry eye syndrome occurs frequently, and symptoms and signs of both disorders overlap making early and accurate differential diagnosis difficult. A differentiation via specific markers is warranted. Tear fluid samples of 120 subjects with TAO, TAO+dry eye, dry eye and controls were collected. The samples were measured using matrix assisted laser desorption ionisation mass spectrometry. The identified proteins where tested with antibody microarrays. Proteomics identified deregulated proteins in TAO and dry eye. Compared to dry eye, Proline-rich-protein 1 (PROL1, p=0.002), UDP-glucose-dehydrogenase (UGDH, p=0.017), Calgranulin A (S10A8, p<0.0001), Transcription-activator BRG1 (SMCA4, p<0.0001), Annexin A1 (p=0.007), Cystatin (p=0.009), Heat shock protein 27 (p=0.03), and Galectin (p=0.04), were markedly down-regulated in TAO. Compared to healthy controls, PROL1 (p<0.05.), Proline-rich protein 4 (PRP4, p<0.05), S10A8...
The removal of excessive melanin pigments that obscure ocular tissue morphology is important to a... more The removal of excessive melanin pigments that obscure ocular tissue morphology is important to address scientific questions and for differential diagnosis of ocular tumours based on histology. Thus, the goal of the present study was to establish an effective and fast melanin bleaching method for paraffin and frozen mouse and human ocular tissues. Paraffin-embedded and frozen ocular specimens from mice and human donors were subjected to bleaching employing two methods. The first employed potassium permanganate (KMnO4) with oxalic acid, and the second 10% hydrogen peroxide (H2O2). To determine optimal bleaching conditions, depigmentation was carried out at various incubation times. The effect of diluents used for 10% H2O2 was assessed using phosphate-buffered saline (PBS), and deionized water. Three different slide types and two fixatives, which were ice-cold acetone with 80% methanol, and 4% paraformaldehyde (PFA) were used to determine the optimal conditions for better tissue adher...
Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, th... more Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, though established since almost one century, is subject of scientific debate. The present study investigated the effect of retrobulbar irradiation using a standardized protocol focussing on long term results. Between 1981 and 1997, 104 patients treated by retrobulbar irradiation (10 to 20 Gray) due to Graves' disease. Twenty-nine of these underwent irradiation as sole treatment (mean follow-up 57 months), while in the remaining 75, it was combined with a systemic steroid treatment (mean follow-up 40 months). Patients were evaluated regarding proptosis, intraocular pressure, lid signs, motility as well as subjective assessment of double vision and retrobulbar pain. While proptosis remained unchanged, lid signs, chemosis and intraocular pressure showed slight and statistically significant improvement. However, these findings were considered to be clinically insignificant. Retrobulbar pai...
International Journal of Radiation Oncology Biology Physics, 2002
Purpose: To evaluate the effectiveness of stereotactic fractionated radiotherapy (SFRT) in the tr... more Purpose: To evaluate the effectiveness of stereotactic fractionated radiotherapy (SFRT) in the treatment of optic nerve sheath meningioma (ONSM).Methods and Materials: Between 1994 and 2000, a total of 39 patients with either primary (n = 15) or secondary (n = 24) ONSM were treated with SFRT and received a median total tumor dose of 54 Gy using 1.8 Gy/fraction.Results: The
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