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PubMed2004

The cost of immunosuppressive therapies currently used in patients with thyroid eye disease.

Thyroid eye disease (TED) is an inflammatory condition of the orbit occurring in patients with autoimmune disease. In patients with mild TED, the most important therapeutic measure is reassurance. In severe cases, immunosuppressive therapy is the mainstay of treatment and around 10 immunosuppressive regimens have been suggested and used in such patients so far. The efficacy of these regimens varies according to the number of studies that have addressed these issues. "Response" to the treatment is also variably defined. However, to the best of our knowledge, no study has reported on the cost of immunosuppressive therapy in such patients. The aim of this study was mainly to provide information concerning the cost of different immunosuppressive regimens that patients with active thyroid ophthalmopathy undergo in different European countries. We have shown that the cheapest treatment is oral glucocorticoids (GC) and the most expensive is iv immunoglobulins. Cyclosporine is the second cheapest treatment. Radiotherapy plus oral GC have a cost between 850-3200 Euro; while SS analogues (SS-a) are expensive with a cost between 5000-10000 Euro. However, it is worth noting that the patients studied so far in this group were only few and most of them selected on a basis of a positive octreoscan, the cost of which has to be considered when choosing this type of treatment. Germany is by far the most expensive country as regards the costs of the main remedies, whereas Greece is the cheapest. Denmark is the most expensive country concerning radiotherapy, while Germany is the cheapest.

Drug Costs↗
PubMed1998

The thyrotropin receptor in thyroid eye disease.

Thyroid eye disease (TED) has an autoimmune etiology, but the nature of the autoantigen that is the target of the initiating event remains unknown. A number of candidates have been proposed based on Western blotting, library screening, and deduction from sequence similarity. A strong favorite is the thyrotropin receptor (TSHR), which is the target of the thyroid stimulating antibodies (TSAB) of Graves' disease (GD). We have recently demonstrated TSHR transcripts in orbital adipose tissue from a patient with TED by Northern blot, transcripts in normal adipose tissue being at the limit of detection. We have shown that the transcripts are translated into protein by immunohistochemical analysis using two monoclonal antibodies to the TSHR generated by genetic immunization. TSHR immunoreactivity is associated with elongated cells with the appearance of a fibroblast, often adjacent to clusters of adipocytes, in orbital biopsies from patients with TED but not in strabismus or pseudotumor biopsies. In animal studies, we have transferred thyroiditis to naive BALBc and NOD mice, using T cells primed to the human TSHR, either using the receptor expressed as a bacterial fusion protein or by genetic immunization. The BALBc develop a Th2-type response to the receptor, but the NOD a Th1-type with thyrocyte destruction. Orbital pathology, edema, infiltration by mast cells and lymphocytes, and adipose accumulation was also induced in 68% of the BALBc but none of the NOD mice. Together these data indicate that the preadipocyte expresses the TSHR and that a Th2 autoimmune response to the receptor may be an initiating event in TED.

Animals↗
PubMed2006

Pharmacological treatments for thyroid eye disease.

Thyroid eye disease (TED), which affects the majority of patients with Grave's disease, is associated with significant ophthalmic morbidity. In patients with mild disease, supportive treatment with lubricating medication can be sufficient. However, in patients with severe TED and disfiguring proptosis or sight-threatening neuropathy, more aggressive medical or surgical interventions are necessary. Corticosteroids remain the preferred pharmacological treatment modality in the majority of patients with an active inflammatory component. Other immunosuppressive drugs in combination with corticosteroids may be helpful in patients with corticosteroid-resistant TED. Newer agents such as somatostatin analogues have not shown to be of significant clinical benefit; however, initial studies on the use of antioxidants and cytokine antagonists are encouraging.

Adrenal Cortex Hormones↗
PubMed2006

Reduced structural proteins in the conjunctival epithelium in allergic eye disease.

AIMS: Allergic eye disease affects up to 20% of the population with varying severity. The conjunctival epithelium plays a key role in allergic eye disease. The purpose of this study was to determine whether the conjunctival epithelium is abnormal in allergic eye disease. METHODS: Conjunctival biopsy samples were taken from patients with seasonal allergic conjunctivitis (SAC) 'in' and 'out of season' and nonatopic control subjects. Specimens were fixed in glycol methacrylate, 2 microm serial sections cut and Image-J used to assess the sites and areas of immuno-staining. RESULTS: E-cadherin, CD44, keratins K5/6, K8, K13, K14, K18 and pan-keratin immuno-staining were all significantly lower in patients 'out of season' compared with normal controls. No structural differences in the epithelium were observed between the two groups. The epithelium of patients 'in season' was thicker and immuno-staining of the above markers similar to controls. CONCLUSIONS: The expression of a wide spectrum of epithelial cell adhesion proteins and cytoskeletal elements is downregulated in the conjunctiva of SAC patients 'out of season' compared with normal controls. We suggest that this could have an important impact on the ability of the epithelium to protect itself against allergen penetration, potentially influencing the development and course of allergic eye disease and offering a novel area for therapeutic control.

Adult↗
PubMed1973

[Eye diseases].

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Eye Diseases↗
PubMedDate not supplied

[Eye diseases].

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Eye Diseases↗
PubMed2001

Persistence of Escherichia coli, Salmonella choleraesuis, Aujeszky's Disease virus and Blue Eye Disease virus in ensilages based on the solid fraction of pig faeces.

AIMS: This study was carried out to determine the survival time of Escherichia coli, Salmonella choleraesuis, Aujeszky's Disease virus and Blue Eye Disease virus in ensilages based on the solid fraction of pig faeces. METHODS AND RESULTS: The four micro-organisms were inoculated into microsilos based on the solid fraction of pig faeces, sorghum and molasses. They were left for 0, 7, 14, 28 and 56 days, after which the state of each microsilo was evaluated, and isolation of the inoculated agents was attempted. The four inoculated agents were isolated only on day 0 of ensilage. The viral agents were identified through the cytopathic effect and fluorescence. CONCLUSIONS, SIGNIFICANCE AND IMPACT OF THE STUDY: It is concluded that ensilages based on the solid fraction of pig faeces appear to reduce the risk of the transmission of the agents inoculated in this study and help to reduce the environmental impact by using the solid in animal feed.

Animals↗
PubMed1998

Endoscopic orbital decompression for thyroid eye disease.

BACKGROUND: Thyroid eye disease is a disorder of immune function resulting in extraocular myopathy and an increase in retrobulbar fat. These changes lead to the clinical features found in thyroid eye disease including proptosis, eyelid retraction, restrictive myopathy and sometimes compressive optic neuropathy. Orbital decompression is undertaken for optic nerve compression, exposure keratopathy or cosmesis. Previously this involved an external approach with the removal of the medial orbital wall along with the floor. An intranasal endoscopic approach with the removal of the medial orbital wall and part of the floor has recently been advocated as an alternative procedure. METHODS: We present the results of 7 patients who underwent endoscopic orbital decompression. The effects on optic nerve function, proptosis and ocular motility were assessed. Symptoms before and after surgery were monitored. RESULTS: The surgery was found to be successful in all cases with a reduction in proptosis and minimal effect on ocular motility. The surgery was also associated with a low post-operative morbidity. CONCLUSION: We suggest endoscopic orbital decompression is an effective and safe treatment for dysthyroid eye disease.

Adult↗
PubMed1983

Plasma lipid transfer in fish-eye disease.

Fish-eye disease is a familial condition characterized by corneal opacities and dyslipoproteinaemia with, i.a., pronounced enrichment of plasma low density lipoprotein (LDL) with triglycerides. Cholesterol ester and triglyceride transferase activities in lipoprotein-free plasma have been measured in two patients with fish-eye disease and found to be normal. This indicates that a deficiency of plasma lipid transfer protein is not involved in the abnormal composition of LDL in fish-eye disease.

Cholesterol Esters↗
PubMed1994

Nutrition and metabolic eye disease.

Certain metabolic eye disorders may be caused by nutritional factors, and others may be treated by nutritional adjustments or withdrawal of certain elements in the diet, and sometimes the inclusion of certain drugs. Occasionally a metabolic eye disease is drug induced. Quite often, certain addition or subtraction to or from the patient's regimen may influence the progress of the metabolic eye disease.

Eye Diseases↗
PubMed1993

Traumatic optic neuropathy complicated by thyroid eye disease.

BACKGROUND: Thyroid eye disease is the most common orbital disorder found in adults. Ocular changes may occur with or without systemic hyperthyroidism. Blunt orbital trauma can affect the eye in many ways and can confound and alter the natural course of thyroid eye disease. METHODS: A 76-year-old patient with a number of ophthalmic findings and associated symptoms which could have been related to previous blunt ocular trauma. Careful optometric evaluation, systemic laboratory testing, and review of the ocular and medical findings demonstrated the onset of thyroid dysfunction. RESULTS: Thyroid disease was diagnosed on the basis of the presence of enlarged extraocular muscles by CT scan and elevated tensions on attempted upgaze. The patient demonstrated an elevated T3 uptake and low TSH levels for which he was treated with propylthiouracil. The occurrence of thyroid disease and damage from blunt trauma confounded the diagnosis because forced duction testing and optic atrophy could well have been the result of previous blunt trauma. CONCLUSIONS: This case elucidates the many differential diagnoses and complications that result from the combination of previous blunt trauma and the occurrence of new thyroid disease with ophthalmic findings.

Aged↗
PubMed2006

Avoiding surgery for thyroid eye disease.

In thyroid eye disease, autoimmune inflammation of orbital musculature and fat increases the bulk of the orbital contents. Orbital tension rises and patients stratify according to the ease with which their globes can proptose. Restriction of proptosis is associated with optic nerve compression and visual loss; exophthalmos, with corneal damage. Ocular motility is affected, initially by muscle inflammation; late in the disease, by fibrosis. Extraocular factors, including thyroid endocrine disturbance, antigen release, infections, malignancies, and smoking, may trigger and drive the orbital myopathy. The management of thyroid eye disease by the identification and treatment of drives, followed by immunomodulatory therapy, is discussed. Fourteen patients with compressive optic neuropathy were treated with immunomodulation using intravenous methylprednisolone, oral prednisolone, and cyclosporin A, and followed up for a minimum of three years. All recovered their pre-morbid visual acuities and visual fields in both eyes. Severe disturbances of ocular motility also recovered in 30 patients, treated with the same regime. In one subject, ocular motility normalised with intravenous steroids and cyclosporin A, but no oral prednisolone. Morbidity from the treatment was low. Immunomodulation is a rational and successful method for managing optic nerve compression and disordered motility in this condition.

Adult↗
PubMed2003

T-cell characterization in chronic allergic eye disease.

Chronic allergic eye disease encompasses several disorders, but it is vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) that have sight-threatening sequelae. T cells, eosinophils, and mast cells are all found in the conjunctiva, and are thought to play a role in disease pathogenesis. Recently, the conjunctival epithelium has also been considered to play a key role. New and effective therapeutic strategies for the future for these patients depend on achieving a greater understanding of the roles and interactions of the cell populations in these sight-threatening disorders.

Chronic Disease↗
PubMed2001

Review of findings of the Andhra Pradesh Eye Disease Study: policy implications for eye-care services.

The Andhra Pradesh Eye Disease Study (APEDS) was conducted in order to design long-term strategies to reduce blindness in the background of non-availability of recent population-based data on various aspects of blindness. The objectives of APEDS were to determine the prevalence and causes of blindness and visual impairment, prevalence of and risk factors for major eye diseases, barriers to eye-care services, and quality of life among the visually impaired. Multistage sampling was used to select 11,786 subjects of all ages from 24 urban clusters and 70 rural clusters in one urban and three rural areas belonging to different parts of Andhra Pradesh, with the aim of obtaining a study sample representative of the urban-rural and socioeconomic distribution of the population of this state. A total of 10,293 subjects underwent a detailed interview and dilated eye examination by trained professionals. The adjusted prevalence of blindness (presenting visual acuity <6/60 or central visual field <20 degrees in the better eye) was 1.84%, and moderate visual impairment (presenting visual acuity <6/18-6/60 or equivalent visual field loss in the better eye) was 8.1%. Cataract and refractive error were responsible for 60.3% of blindness and 85.7% of moderate visual impairment. Increasing age, decreasing socioeconomic status, female gender, and rural area of residence were associated with higher risk of blindness. Projections from APEDS suggest that there were 18.7 million blind people in 2000 in India, and that this number is likely to increase to 24.1 million and 31.6 million in 2010 and 2020 respectively, if the current trend continues. This review summarizes the findings of APEDS and discusses the implications of these data on the policy and planning of eye-care services.

Blindness↗