The pathogenesis of Graves' ophthalmopathy (GO) remains to be entirely elucidated. The present study aimed to determine the association between phenotypic expression of the MTHFR gene and susceptibility to GO in patients with Graves' disease (GD). A prospective case‑controlled study was conducted with 122 patients with GD and GO (n=72) or without GO (n=50) and 100 healthy controls in South Korea. Patient history, including smoking, nutritional status, thyroid function and antithyroid antibodies were investigated and clinical activity score, VISA classification (which includes vision, inflammation, strabismus and appearance/exposure) and orbit computed tomography were evaluated. Fasting plasma total homocysteine (tHcy) concentration was measured, and genotype analysis of the MTHFR gene was conducted. The TT homozygous genotype was associated with a two‑fold increased risk of GO [adjusted odds ratio (AOR), 2.19; 95% confidence interval (CI), 0.78‑6.14]. However, this result was not significant. The TT genotype significantly increased the risk of GO compared with that in healthy controls (AOR, 2.92; 95% CI, 1.11‑7.65). The MTHFR 677CT/1298AA genotype decreased the risk of GO in patients with GD (AOR, 0.26; 95% CI, 0.08‑0.91). tHcy levels in patients with GD without GO were significantly higher than in patients with GO, however, they were within the normal limit. The current study identified an association between MTHFR polymorphisms and GO. These results will aid understanding of the pathogenesis of GO and facilitate development of genetic therapeutic strategies.
PurposeTo evaluate the efficacy and safety of customized orbital decompression surgery combined with eyelid surgery or strabismus surgery for mild to moderate thyroid-associated ophthalmopathy (TAO).MethodsTwenty-seven consecutive subjects who were treated surgically for proptosis with disfigurement or diplopia after medical therapy from September 2009 to July 2012 were included in the analysis. Customized orbital decompression surgery with correction of eyelid retraction and extraocular movement disorders was simultaneously performed. The patients had a minimum preoperative period of 3 months of stable range of ocular motility and eyelid position. All patients had inactive TAO and were euthyroid at the time of operation. Preoperative and postoperative examinations, including vision, margin reflex distance, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and subject assessment of the procedure, were performed in all patients. Data were analyzed using paired t-test (PASW Statistics ver. 18.0).ResultsForty-nine decompressions were performed on 27 subjects (16 females, 11 males; mean age, 36.6 ± 11.6 years). Twenty-two patients underwent bilateral operations; five required only unilateral orbital decompression. An average proptosis of 15.6 ± 2.2 mm (p = 0.00) was achieved, with a mean preoperative Hertel measurement of 17.6 ± 2.2 mm. Ocular motility was corrected through recession of the extraocular muscle in three cases, and no new-onset diplopia or aggravated diplopia was noted. The binocular single vision field increased in all patients. Eyelid retraction correction surgery was simultaneously performed in the same surgical session in 10 of 49 cases, and strabismus and eyelid retraction surgery were performed in the same surgical session in two cases. Margin reflex distance decreased from a preoperative average of 4.3 ± 0.8 to 3.8 ± 0.5 mm postoperatively.ConclusionsThe customized orbital decompression procedure decreased proptosis and improved diplopia, in a range comparable to those achieved through more stepwise techniques, and had favorable cosmetic results when combined with eyelid surgery or strabismus surgery for mild to moderate TAO.
Thus, transplantation of hoADSCs with HAG is a safe and effective technique for orbital fat volume expansion. This is a new and promising method for orbital reconstruction and aesthetic orbital volume augmentation.
Purpose: We investigated the efficacy and safety of a fixed combination of bimatoprost (0.03% w/v) and timolol (0.5% w/v) (Ganfort<sup>®</sup> , Allergan Inc., Irvine, CA, USA; fixed combination of bimatoprost-timolol, BTFC) for open-angle glaucoma patients.Methods: We included 25 right eyes with open-angle glaucoma treated with eye drops. The drops were changed to the BTFC without a wash-out period. The therapeutic and adverse effects were evaluated by comparing the intraocular pressure (IOP) before the change to that at 1, 4, 7, and 10 months thereafter.Results: The mean IOP before the instillation of eyedrop and the mean reduction of IOP at each time was 18.66 ± 8.22 mmHg (n = 21) and 2.47 ± 3.19 mmHg (13.24%) at 1 month, 19.05 ± 8.54 mmHg (n = 18) and 3.68 ± 5.55 mmHg (19.32%) at 4 months, 16.68 ± 2.52 mmHg (n = 16) and 2.13 ± 2.87 mmHg (12.77%) at 7 months, and 20.07 ± 9.91 mmHg (n = 14) and 2.79 ± 4.48 mmHg (13.90%) at 10 months (<i>p</i> < 0.05). Side effects included soreness (two eyes, 7.7%), red eye and allergic symptoms (three patients, 11.5%), and discomfort (three patients, 11.5%); there were no severe adverse events such as permanent vision loss or systemic side effects.Conclusions: BTFC reduced the IOP of open-angle glaucoma patients without causing permanent vision loss or any other serious side effects.
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