Magnetic resonance imaging evaluation of head and neck involvement in IgG4-related disease

Objective:To evaluate the radiological features of IgG4-related disease(IgG4-RD)in the head and neck region.Methods:In this radiology-based study,radiological features,clinical,laboratory,pathological findings,and prognosis of nine patients with head and neck involvement diagnosed with IgG4-RD were investigated retrospectively.Results:The median age of the patients was 38 years(range:2.5-79 years),and there were six males and three females.The most common symptoms and clinical findings of the patients were eyelid and lacrimal gland swelling,painless exophthalmos,and ophthalmoplegia.The most common site of involvement on MRI was the orbit.Orbital involvement was followed by branches of the trigeminal nerve,sinonasal cavity,cervical lymph nodes,and dural involvement.The most common and remarkable imaging features were T2 hypointensity and diffuse homogeneous contrast enhancement.Conclusions:Head and neck involvement of the IgG4-RD,has specific imaging features that can help with diagnosis.Thus,early diagnosis and better outcomes can be achieved with increasing awareness of these features of this relatively new pathology.

Evaluation of macular choroidal and microvascular network changes by activity scores and serum antibodies in thyroid eye patients and healthy subjects

AIM:To investigate the choroidal thickness and the microvascular network changes around the macula in thyroid eye disease(TED)patients at different stages and the relationship of those changes with risk factors,serum antibodies and the severity of TED.METHODS:A total of 85 participants were enrolled.All participants underwent ophthalmology and endocrinology examinations.Subfoveal choroidal thickness(SFCT),superficial(s)and deep(d)foveal avascular zone(FAZ)area,mean(m)and central(c)superficial vascular density(SVD),deep vascular density(DVD)measurements of the enrolled cases were performed with Topcon swept source optical coherence tomography(OCT)/OCT angiography(OCTA)DRI OCT Triton.Multiple linear regression analysis was used to explore the associations between SFCT,FAZ area,SVD,DVD and the relevant factors of TED.RESULTS:Those with active TED patients had higher c-DVD and m-DVD levels(P<0.05),however there is no statistically significant difference in SFCT between active and stable TED patients.Among the serum antibodies,it was observed that s-FAZ and d-FAZ increased,c-SVD and m-SVD decreased in patients with high thyroid stimulating hormone-receptor autoantibodies(TRAB)level,whereas SFCT thickened in patients with high levels of both TRAB and human thyroglobulin(hTG).There was no significant difference in SFCT,FAZ,SVD and DVD measurement at gender,between hyperthyroid and euthyroid patients and among those with or without thyroid papillary carcinoma.CONCLUSION:The results show that both disease activation and serum antibodies differentially affect both superficial and deep retinal vascular density.It has also been shown that high serum antibody levels affect choroidal thickness independent of clinical activity.

Epidemiological and clinical features of paediatric open globe injuries in southwestern Turkey

AIM:To evaluate the epidemiologic,anatomic,and clinical features of open globe injuries in children.METHODS:The medical files of patients under the age of 16 who had been operated for an open globe injury at Akdeniz University Hospital’s Department of Ophthalmology were retrospectively evaluated.RESULTS:A total of 90 patients were evaluated in this study.Among these patients,26(28.9%)were female and64(71.1%)were male.The mean age of the patients was7.7±4.2 years.The male/female ratio was observed to increase with increasing age(P=0.006,P=7.48).Injuries were most likely to occur in spring and autumn(P=0.028).The time interval between the injury and the surgical repair was 9.36±27.4h.Forty(44.4%)of the injuries occurred in the home,27(30%)occurred in the yard,and 21(23.3%)happened while playing in the street.The most common causes of injury were sharp metal objects(P【0.001).Injury to the cornea occurred in47(52.2%)of the patients(P【0.001).The most common complication to occur was cataract formation.Additional operations were necessary for 37(41.1%)of the patients.The final visual acuity was correlated with both the initial visual acuity of the wounded eye prior to surgery and the length of the wound(P【0.001,r=0.502 and P【0.001,r=-0.442,respectively).CONCLUSION:Open globe injuries that are suffered in childhood generally occur either at home,in the yard,or on the street,with sharp metal objects being the most common cause of injury.The initial visual acuity and the length of the wound are the most important determinants of the final visual acuity.

Surgical results of the slipped medial rectus muscle after hang back recession surgery

AIM: To analyze the surgical results of a slipped medial rectus muscle(MRM) after hang back recession surgery for esotropia.METHODS: Twenty-one patients who underwent reexploration for diagnosed slipped muscle after hang back recession surgery were included in this retrospective study. Dynamic magnetic resonance imaging was performed to identify the location of the slipped muscle.Ocular motility was evaluated with assessment with prism and cover test in gaze at cardinal positions. The operations were performed by the same consultant.Intraoperative forced duction test was performed under general anesthesia. The empty sheath of the slipped MRM was resected and the muscle was advanced to the original insertion site in all patients.RESULTS: The average age of 21 patients who had consecutive exotropia with a slipped MRM at the time of presentation was 17.4±5.4y(5-50y). The average duration between the first operation and the diagnosis of the slipped muscle was 25mo(12 to 36mo). The mean follow up after the corrective surgery was 28 mo. The mean preoperative adduction limitation in the field of action of the slipped muscle was-2.26(ranging from-1 to-4). All patients had full adduction postoperatively.CONCLUSION: The diagnosis of the slipped muscle should be confirmed during the strabismus surgery. The slipped muscle may be caused due to insufficient suture and excessive rubbing of the eye. When divergent strabismus is observed after the recession of the MRM, a slipped muscle should be considered in the differential diagnosis.