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At least 37 records · Page 2Linked to original sources
PubMed2001

B-cell autoepitopes on the acetylcholinesterase-homologous region of human thyroglobulin: association with Graves' disease and thyroid eye disease.

OBJECTIVE: Thyroglobulin (Tg) is a large autoantigen involved in autoimmune thyroid diseases. Tg epitopes have, so far, been identified within large peptides. In the present study, we used small synthetic peptides to finely map serological epitopes on the highly immunogenic C-terminal region of Tg. Homology of this region to acetylcholinesterase (AChE) has been implicated in the pathogenesis of thyroid eye disease (TED) through cross-reactive antibodies. METHODS: We tested total IgG purified from four pilot Graves' disease (GD) sera reactive with both Tg and AChE and from three healthy controls, for reactivity against overlapping 20mer peptides (pin synthesis) covering the sequence 2171-2748 of human Tg. Antibody-reactive peptides were subsequently synthesized by a solid-phase technique for confirmation with a large number of sera: 99 GD, 32 Hashimoto's thyroiditis (HT) and 45 healthy controls. RESULTS: Peptides TgP15, TgP26 and TgP41 (amino acids 2339-2358, 2471-2490 and 2651-2670 respectively) were found to be targets of autoantibodies on intact Tg, recognized by a statistically significant proportion of GD sera (22.2%, 35.4% and 30.3% respectively), compared with HT (0%, 15.6% and 6.3% respectively) and healthy controls (0%, 4.4% and 4.4% respectively). The majority of GD sera (56.6%) were positive for at least one of the three peptides. In GD, TgP26 reactivity was found to be associated with TED (48.6% with TED versus 25.5% without TED, P<0.05). CONCLUSION: Some epitopes on the C-terminal region of Tg are associated with GD. A subset of Tg-reactive autoantibodies, directed to this region, is associated with TED and may be involved in the development of the disease.

Acetylcholinesterase↗
PubMed1988

Immunosuppressant therapy of thyroid eye disease.

Thyroid eye disease is attributed to an autoimmune process where both cellular and humoral immunity play a role. In this report, after a short introduction dealing with immunopathogenesis of the disease, immunosuppressant therapy is discussed. Treatment with glucocorticoids (as the standard substance), nonsteroid immunosuppressants (azathioprine, cyclophosphamide, lately cyclosporin) and with the immunomodulatory substance ciamexone is reviewed. Retroorbital irradiation as a "local" immunosuppressive method and plasmapheresis are also discussed. While systemic glucocorticoids and to a lesser extent orbital radiotherapy are routinely administered for severe Graves' ophthalmopathy, nonsteroid immunosuppressants and plasmapheresis are not yet part of the established treatment of thyroid eye disease. Their use should currently remain confined to controlled studies.

Graves Disease↗
PubMed2006

Pharmacotherapy of allergic eye disease.

Allergic eye disease is a term that refers to a number of disease processes that affect about one-fifth of the world's population. Although the more advanced forms of the disease can be sight threatening, the most disabling effects are due to the clinical manifestations, and hence quality of life, with some patients having seasonal exacerbations of their symptoms, whereas others have symptoms that are present throughout the year. Recent increased understanding of the cellular and mediator mechanisms that are involved in the various disease manifestations has greatly facilitated the development of more effective treatment options. Newer topical medications are being used that have multiple actions, such as an antihistaminic effect coupled with mast-cell stabilisation, and which require reduced daily dosing due to their longer duration of action. With greater research into newer therapies and more effective modes of delivery, improved healthcare outcomes with a lower economic burden will be achieved for patients with allergic eye disease.

Administration, Oral↗
PubMed1994

Blindness in different types of eye disease. A study based on the records of the Department of Eye Diseases in the Medical University, Plovdiv for the period 1982-1991.

Between 1982 and 1991, inclusive, a total of 13718 patients were treated in the Department of Eye Diseases in Plovdiv University of Medicine. Cataract patients formed the most numerous group (19.71%), followed by those with diseases of the retina (9.53%), glaucoma (7.95%), uveitis (4.9%), diseases of the cornea (3.86%), malignant tumors of the eyelids and the eyeball (2.29%) and diseases of the optic nerve (1.54%). Of these 13718 patients, 1727 (12.58%) had monocular and binocular vision below 0.08. The patients with visual acuity from 0 to 0.03 were 1330 (9.69%). Nosologically, they were distributed as follows: glacoma-422 (3.07%), eye traumas-281 (2.04%), diseases of the retina-270 (1.96%), diseases of the cornea-89 (0.64%), cataract-80 (0.58%), uveitis-77 (0.56%), malignant tumors of the eyelids and the eyeball-66 (0.48%), and diseases of the optic nerve-45 (0.32%). Glaucoma was found to be the most common cause of blindness among the patients treated in the Department of Eye Diseases, followed by eye traumas and disease of the retina. The importance of the vascular factor in inducing blindness is undeniably great. It is the underlying cause of the open-angle glaucoma, the diseases of the retina and the optic nerve.

Blindness↗
PubMed2006

Fluorophotometry as a diagnostic tool for the evaluation of dry eye disease.

BACKGROUND: Dry eye disease is a common debilitating ocular disease. Current diagnostic tests used in dry eye disease are often neither sensitive nor reproducible, making it difficult to accurately diagnose and determine end points for clinical trials, or evaluate the usefulness of different medications in the treatment of dry eye disease. The recently developed fluorophotometer can objectively detect changes in the corneal epithelium by quantitatively measuring its barrier function or permeability. The purpose of the study is to investigate the use of corneal fluorescein penetration measured by the fluorophotometer as a diagnostic tool in the evaluation of dry eye patients. METHODS: Dry eye patients (16 eyes), who presented with a chief complaint of ocular irritation corresponding with dry eye, low Schirmer's one test (<10 mm after 5 minutes) and corneal fluorescein staining score of more than two, were included in the study. Normal subjects (16 eyes), who came for refraction error evaluation, served as controls. Institutional Review Board (IRB) approved consent was obtained before enrolling the subjects in the study and all questions were answered while explaining the risks, benefits and alternatives. All Fluorophotometry of the central corneal epithelium was done utilizing the Fluorotron Master. Each eye had a baseline fluorescein scan performed, after which 50 l of 1% sodium fluorescein dye was instilled. Three minutes later, the fluorescein was washed with 50 ml of normal saline. Fluorescein scans were then started immediately after washing and were recorded at 10, 20, 40, and 60 minutes thereafter. The corneal peak values of fluorescein concentration were recorded within the central cornea in both dry eyes and in controls. RESULTS: Ten minutes after fluorescein installation, patients with dry eye disease averaged a five-fold increase in corneal tissue fluorescein concentration (mean = 375.26 +/- 202.67 ng/ml) compared with that of normal subjects (mean = 128.19 +/- 85.84 ng/ml). Sixty minutes after dye installation, patients with dry eye disease still revealed higher corneal tissue fluorescein concentration (mean = 112.87 +/- 52.83 ng/ml) compared with that of controls (mean = 40.64 +/- 7.96 ng/ml), averaging a three-fold increase. CONCLUSION: Patients with dry eye disease demonstrated an increased corneal permeability and a slower rate of elimination to topically administered fluorescein when measured by the fluorophotometer. This suggests that fluorophotometry may serve as a valuable quantitative and objective tool for the diagnosis of dry eye disease, and in following patients' response to new treatment modalities. Fluorophotometry may serve as an objective non-invasive tool for end-point analysis in clinical trials of new treatments for dry eye disease.

Adult↗
PubMed2000

Oral acyclovir for herpes simplex virus eye disease: effect on prevention of epithelial keratitis and stromal keratitis. Herpetic Eye Disease Study Group.

OBJECTIVES: To investigate the effect of oral acyclovir therapy for recurrences of herpes simplex virus (HSV) epithelial keratitis and stromal keratitis and to determine if certain patients derive differential benefit. DESIGN: This randomized, double-masked clinical trial enrolled 703 immunocompetent patients with prior HSV eye disease within the preceding year; assigned 357 patients to receive oral acyclovir, 800 mg/d, and 346 to receive placebo; and followed up patients during a 12-month treatment period for the development of HSV eye disease. RESULTS: The cumulative probability of a recurrence of any type of ocular HSV disease during the 1-year treatment period was 19% in the acyclovir group compared with 32% in the placebo group. Sixteen patients in the acyclovir group and 30 in the placebo group had more than 1 recurrence. A benefit was seen for preventing both epithelial keratitis (rate ratio, 0.62; 95% confidence interval, 0.39-0.97) and stromal keratitis (rate ratio, 0. 57; 95% confidence interval, 0.36-0.89). Although a relative benefit of treatment on preventing any type of recurrence was present in most subgroups, the magnitude of absolute benefit was greatest among patients with the highest number of prior episodes of ocular HSV disease. The benefit in preventing stromal keratitis was seen solely among patients with a history of stromal keratitis. CONCLUSIONS: Long-term suppressive oral acyclovir therapy reduces the rate of recurrent HSV epithelial keratitis and stromal keratitis. Acyclovir's benefit is greatest for patients who have experienced prior HSV stromal keratitis. Arch Ophthalmol. 2000;118:1030-1036

Acyclovir↗
PubMed2000

Managing eye disease in primary care. Part 1. How to screen for occult disease.

Proper eye screening is the first step in detection of occult eye disease in asymptomatic patients. Knowing which patients are at high risk and should be referred for a comprehensive eye examination is the key. In part 1 of this three-part article, Dr Shields explains how to identify high-risk patients and offers practical pointers for performing visual acuity measurements and other necessary testing in children. A list of resources on vision care for both patients and physicians is also included.

Adolescent↗
PubMed2000

The Age-Related Eye Disease Study: a clinical trial of zinc and antioxidants--Age-Related Eye Disease Study Report No. 2.

The Age-Related Eye Disease Study includes a clinical trial of high dose antioxidant and zinc supplements for age-related macular degeneration and a clinical trial of high dose antioxidants for cataract. The clinical trials were initiated largely because of the widespread public use in the United States of commercially available pharmacological doses of vitamins and minerals to treat these two eye conditions and the absence of definitive studies on the safety and efficacy of their use. This report focuses on the clinical trial of zinc and the possibility that this elderly study cohort, who were randomly assigned in a factorial design to receive zinc, antioxidants and placebo, could be assessed for zinc effects other than those currently addressed by the trial.

Aged↗
PubMed2006

Atopic disease and herpes simplex eye disease: a population-based case-control study.

PURPOSE: To determine whether atopy is associated with herpes simplex virus (HSV) ocular disease. DESIGN: Retrospective, population-based, case-control study. METHODS SETTING: Large, regional health maintenance organization (Northern California Kaiser Permanente). STUDY POPULATION: 1,042,351 people over a one-year period. OBSERVATION PROCEDURES: Electronic database search for HSV ocular disease and subsequent chart review determined study eligibility. Two age-matched control groups (one population-based and one clinic-based) were randomly chosen. Medical record review determined the presence of atopy. Severe atopic disease was defined by diagnostic code or illness requiring an emergency room visit, hospitalization, or treatment with a systemic corticosteroid. MAIN OUTCOME MEASURES: Presence of HSV eye disease, presence of atopy, and characterization of atopy severity. RESULTS: HSV eye disease was found in 172 patients. HSV cases had a greater prevalence of atopy (34%, 58/172) than the clinic-based (25%, 43/172) or the population-based controls (21%, 36/172, odds ratio (OR) 1.5, 95% confidence interval (CI) 0.9 to 2.6 and OR 1.9, 95%, CI 1.1 to 3.3, respectively). The association of HSV ocular disease with severe atopy was even greater, with a history of severe atopic disease in 13% (22/172) of patients with HSV ocular disease as compared with 6% (11/172) of patients in the clinic control group and 3% (5/172) of patients in the population control group (OR 2.0, 95% CI 0.7 to 5.9 and OR 4.8, 95% CI 1.6 to 19.2, respectively). CONCLUSIONS: Patients with HSV ocular disease are more likely to have a history of atopic disease, especially severe atopic disease, than age-matched controls.

Case-Control Studies↗
PubMed2001

The Age-Related Eye Disease Study system for classifying age-related macular degeneration from stereoscopic color fundus photographs: the Age-Related Eye Disease Study Report Number 6.

PURPOSE: To describe the system for grading age-related macular degeneration from fundus photographs in the Age-Related Eye Disease Study. This is a prospective multicenter cohort study of the course of age-related macular degeneration and a placebo-controlled clinical trial of the effect of high-dose vitamin and mineral supplements on development of advanced age-related macular degeneration. METHODS: Standardized stereoscopic 30-degree color fundus photographs are taken at 11 clinical centers and evaluated by graders at a reading center for quality and age-related macular degeneration abnormalities. Macular subfields are defined by a grid, and presence and severity of various age-related macular degeneration abnormalities are graded using standard/example photographs and measuring circles. Advanced age-related macular degeneration abnormalities (presence/absence) include retinal pigment epithelial detachment, serous (or hemorrhagic) sensory retinal detachment, hard exudates, subretinal/subretinal pigment epithelial hemorrhage, subretinal fibrous tissue, and photocoagulation scars. Other abnormalities (multistep scales) include retinal pigment epithelial abnormalities (geographic atrophy, depigmentation, and increased pigment), and drusen (size, type [hard versus soft distinct or indistinct], and total area). Contemporaneous variability is tested by having different graders evaluate samples of photographs, and temporal variability by annual regrading of a dedicated subset. RESULTS: In a cumulative sample of 1230 eyes for contemporaneous reproducibility, agreement on advanced age-related macular degeneration was 96% (kappa = 0.88) and for four-step age-related macular degeneration level was 83% (kappa = 0.77). Agreement was moderate for pigment epithelial detachment (kappa = 0.54) and substantial for serous sensory retinal detachment, hard exudates, subretinal/subretinal pigment epithelial hemorrhage, subretinal fibrous tissue, and central geographic atrophy (kappa = 0.73-0.82). For pigment abnormalities, agreement was substantial for geographic atrophy (kappa = 0.63; kappa(weighted) = 0.71, 0.75 weight for one-step disagreements), and moderate for depigmentation (kappa = 0.41, kappa(weighted) = 0.51) and increased pigment (kappa = 0.54, kappa(weighted) = 0.71). For drusen, agreement was moderate to substantial for presence/maximum size (kappa = 0.50, kappa(weighted) = 0.68), type (kappa = 0.61, kappa(weighted) = 0.69), and area (kappa = 0.56, kappa(weighted) = 0.77). Six annual regrades of 119 eyes showed little temporal drift in grading of various age-related macular degeneration abnormalities, except for drusen type. CONCLUSIONS: The Age-Related Eye Disease Study has demonstrated satisfactory reliability for detecting onset of advanced age-related macular degeneration in a cohort, and moderate to substantial agreement on various abnormalities across the age-related macular degeneration spectrum. The Age-Related Eye Disease Study system for classification of age-related macular degeneration is suitable for longitudinal multicenter studies.

Cohort Studies↗
PubMed1996

Visual sensitivity and age-related eye diseases. The Beaver Dam Eye Study.

OBJECTIVE: To evaluate the relationships between visual sensitivity and age-related ocular disorders. DESIGN: Prevalence survey of age-related eye diseases. SETTING: Beaver Dam, Wisconsin. PARTICIPANTS: A total community sample of persons 43-84 at the time of the census (1987-1988) was invited to participate (n = 5.926). MAIN OUTCOME MEASURE: Visual sensitivity was measured by a perimeter. Sensitivities were evaluated with regard to age, sex and age-related eye diseases. RESULTS: Sensitivity was inversely associated with age and was lower in women in each age stratum. Central cataract, cataract surgery, and late age-related maculopathy were significantly related to decreased sensitivity in multivariate analyses. CONCLUSIONS: Visual sensitivity, an indication of the ability of the eye to detect a light stimulus, was diminished in those with central cataract, cataract surgery, and late age-related maculopathy. This may be related to diminished vision in environmental conditions of low illumination. Since visual sensitivity is relative easy to determine, this test may have use as a surrogate to assess functional vision loss. Also, although cataract surgery often leads to improved high contrast acuity, there may be a loss in low contrast settings.

Adult↗
PubMed2002

Management of thyroid eye disease.

Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.

Antithyroid Agents↗
PubMed2005

Novel approaches in the treatment of angiogenic eye disease.

Angiogenic eye disease is among the most common causes of blindness worldwide. Current treatment approaches are insufficiently effective and partially associated with significant adverse effects. From an investigational view, the eye provides an ideal setting to observe real-time and serial observations of angiogenesis in vivo in humans. The current understanding of molecular biology involved in angiogenesis has already led to the identification of a number of potential therapeutic targets, some of them being highly effective angiostatic molecules. Most experimental approaches currently favour or even require the systemic administration of the investigated substances (somatostatin analogues, PKC-inhibitors). However, the systemic administration of bioactive substances always risks significant systemic adverse effects. Due to the morphological characteristics of the eye, local therapies including intraocular injection or even local gene transfer might be feasible. They might provide a valuable opportunity of targeted and sustained delivery of therapeutic proteins to the retina. This review aims to outline the current understanding of the pathogenesis of proliferative diabetic retinopathy and will focus on some as yet experimental, but potentially effective new therapeutic possibilities of this disease.

Animals↗
PubMed1998

Surgical treatment of thyroid eye disease.

Thyroid eye disease may result in exophthalmos, diplopia, and eyelid malpositions, which can be corrected with different surgical procedures. Several techniques for decompressing the orbit have been described, and the advantages and disadvantages of the techniques are discussed. Our own results of the transantral approach are briefly summarized. Eye muscle surgery should be performed after an orbital decompression, and it is not unlikely that more than one muscle operation will be needed in order to achieve single vision. A number of operative procedures for eyelid surgery have been described, and the results of the various methods are generally good.

Eyelids↗