Selenium supplementation in thyroid associated ophthalmopathy: an update

·The therapeutic effect of selenium(Se)has already been proven in thyroid disease and thyroid associated ophthalmopathy(TAO).In spite of clear scientific proof of its benefits in TAO,there appears to be no clear agreement among the clinicians regarding its optimum dose,duration of the treatment,efficacy and safety to date.In this review,the author summarises the findings of 135 English language articles published on this subject over the past four decades from 1973 to 2013.The regulation and metabolism of thyroid hormones require a steady supply of Se and recent studies have revealed several possible mechanisms by which Se improves the severity of thyroid disease and TAO.These mechanisms include 1)inhibitory effect of HLA-DR molecule expression on thyrocytes;2)profound reductions of thyroid stimulating hormone(TSH)receptor antibodies(TSHR-Ab)and TPO antibodies(TPO-Ab);3)prevention of dysregulation of cell-mediated immunity and B cell function;4)neutralising reactive oxygen species(ROS)and inhibition of redox control processes required for the activation,differentiation and action of lymphocytes,macrophages,neutrophils,natural killer cells involved in both acute and chronic orbital inflammation in TAO;5)inhibition of expression of proinflammatory cytokines and 6)inhibition of prostaglandin and leukotriene synthesis.An increased oxidative stress has been observed in both acute and chronic phases of thyroid disease with raised tissue concentrations of ROS.The benefits of Se supplementation in individuals with TAO appear to be proportionate to the degree of systemic activity of the thyroid disease.The maximal benefit of Se supplementation is therefore seen in thesubjects who are hyperthyroid.Restoration of euthyroidism is one of the main goals in the management of TAO and when anti-thyroid drugs are combined with Se,the patients with Graves’disease(GD)and autoimmune thyroiditis(AIT)achieved euthyroidism faster than those treated with anti-thyroid drugs alone.Se status of normal adult humans can vary widely and Se supplementation may confer benefit only if serum Se levels are insufficient.The author recommends that serum Se levels of patients with TAO to be assessed prior to and during Se supplementation at regular intervals to avoid potential iatrogenic chronic Se overdose.

Ischemic penumbra in retina endures： vascular neuropathology is reconciled

A physiological state of＂normoxia＂obtains when tissue oxygen tension（pO_2）is sufficient to drive mitochondrial respiration throughout a volume of cells.Between 30-40%of the available oxygen is normally extracted from hemoglobin as it passes through neural tissue.

Non-keratinising undifferentiated nasopharyngeal-type carcinoma of the lacrimal sac

Dear Editor,We present a case of non-keratinising undifferentiated nasopharyngeal-type carcinoma(UNPC)of nasolacrimal sac and review the previously reported cases and their treatment options and prognosis.Squamous cell carcinoma with a characteristic lymphoid stroma is a type of poorly differentiated carcinoma typically occurring in the nasopharynx[1].Non-keratinising UNPC,so called lymphoepithelioma-like carcinoma(LELC),of the lacrimal

Proteome alterations in aqueous humour of primary open angle glaucoma patients

AIM: To unravel the primary open angle glaucoma(POAG) related proteomic changes in aqueous humour(AH).METHODS: Totally 35 patients listed for cataract surgery(controls: n=12, age: 67.4±13.6 y) or trabeculectomy for POAG(n=23, age: 72.5±8.3 y) were included. AH samples of those patients were obtained during cataract surgery or trabeculectomy. AH samples were subsequently pooled into the experimental groups under equal contribution in terms of protein amount of each individual patient. Protein samples were analyzed by a linear trap quadrupol Orbitrap Mass Spectrometry device with an upstream liquid chromatography system. The obtained raw data were analyzed using the Maxquant proteome software and compared. Proteins with a fold-change ratio higher than a cut-off of 2 were considered as noticeably altered.RESULTS: A total number of 175 proteins could be identified out of the AH from POAG and cataract by means of quantitative mass spectrometric analysis. Apolipoprotein D(fold change, 3.16 times), complement C3(2.96), pigment epithelium-derived factor(2.86), dickkopf-related protein 3(2.18) and wingless-related integration(Wnt) inhibitory factor 1(2.35) were significantly upregulated within the AH of glaucoma compared to cataract serving as controls.CONCLUSION: AH provides a tool to analyze changes in glaucoma and shows striking changes in Wnt signaling inhibitory molecules and other proteins.

在Ⅰ期和Ⅱ期临床试验中,使用表皮生长因子受体酪氨酸激酶抑制剂——吉非替尼(易瑞沙,ZD1839)治疗实体肿瘤患者后其眼部的表现

Purpose: To describe the strategy used for large-scale ophthalmological monitoring in the clinical development of the novel anticancer agent gefitinib (“ Iressa” , ZD1839), an epidermal growth factor receptor tyrosine kinase inhibitor, which had demonstrated ocular effects in preclinical animal models. Methods: In this extensive clinical trial programme, patients in Phase I and II trials underwent frequent and intensive ophthalmological monitoring at baseline and during the trials. Data were reviewed by an external independent Ophthalmology Advisory Board. Results: Ophthalmological data for 221 patients in Phase I trials of gefitinib and 425 patients in Phase II trials revealed no evidence of any consistent or drug-related ophthalmological toxicity. Interestingly, the baseline data revealed that, in an asymptomatic population, transient ophthalmological events are identified during monitoring. Conclusions: This study reports the methodology and normative data in an ophthalmological screening programme that should prove useful for future studies.

Does high intraocular pressure exclude an open globe injury?

Dear Sir,Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable diagnostic and management strategies for open-globe injuries[1].Amongst many types of ocular trauma,the open globe injury is the most serious due to its very poor visual prognosis and young population of patients are mostly affected[2].The treatment outcome may be improved by prompt diagnosis,and immediate surgical repair performed to high standard[3].Amongst the other clinical signs the intraocular pressure(IOP)is found to be particularly reduced and conventionally this is considered as a very reliable indicator of occult globe

An enhanced functional ability questionnaire(faVIQ) to measure the impact of rehabilitation services on the visually impaired

AIM: To develop a short,enhanced functional ability Quality of Vision(faVIQ) instrument based on previous questionnaires employing comprehensive modern statistical techniques to ensure the use of an appropriate response scale,items and scoring of the visual related difficulties experienced by patients with visual impairment. · METHODS: Items in current quality-of-life questionnaires for the visually impaired were refined by a multi-professional group and visually impaired focus groups. The resulting 76 items were completed by 293 visually impaired patients with stable vision on two occasions separated by a month. The faVIQ scores of 75 patients with no ocular pathology were compared to 75 age and gender matched patients with visual impairment. ·RESULTS: Rasch analysis reduced the faVIQ items to 27. Correlation to standard visual metrics was moderate(r =0.32-0.46) and to the NEI-VFQ was 0.48. The faVIQ was able to clearly discriminate between age and gender matched populations with no ocular pathology and visual impairment with an index of 0.983 and 95% sensitivity and 95% specificity using a cut off of 29.·CONCLUSION: The faVIQ allows sensitive assessment of quality-of-life in the visually impaired and should support studies which evaluate the effectiveness of low vision rehabilitation services.

一次性眼压计与Goldmann压平式眼压计的临床应用比较

Purpose:Applanation tonometry as performed in routine clinical practice is a significant potential vehicle for cross-infection particularly in an emergency eye care setting.The aim of this study is to evaluate the accuracy and reliability of three single-use devices(Tonoshield,Tonosafe,Tonojet)as an alternative to standard Goldmann prisms in an emergency eye department.Methods:All patients attending the eye casualty at the Manchester Royal Eye Hospital for a period of 4 months who required intraocular pressure measurement were eligible for this prospective study.Exclusion criteria were:age below 18 years,corneal anomalies that might affect measurement,and refusal to participate.After taking informed consent,the patient was examined by one experienced nurse practitioner,who measured the intraocular pressure three times.In the first part of the study,we compared the standard Goldmann prism vs Tonoshield and Tonosafe prisms,while for the second part of the study we used standard Goldmann,Tonosafe,and Tonojet prisms.Agreement and repeatability tests were carried out on separate samples.Results:Tonosafe and Tonojet correlated well with standard Goldmann tonometry(P< 0.001),while the measurements obtained with Tonoshield were higher,especially for raised intraocular pressure measurements.Tonojet and Tonosafe measurements were more reproducible than Tonoshield measurements.Conclusions:This study shows that Tonosafe and Tonojet are accurate and reliable alternatives to standard Goldmann tonometry.

黏多糖增多症的眼部特征

Aims:The mucopolysaccharidoses(MPS)are a heterogeneous group of rare disorders characterised by accumulation of glycosaminoglycans within multiple organ systems.This study aimed to determine the prevalence and severity of ocular complications in patients with MPS.Methods:Clinical ophthalmic features and electrodiagnostic results of 50 patients with a diagnosis of MPS were retrospectively reviewed.Results:A total of 79% of MPS IH patients had a visual acuity of less than 6/12 equivalent in their better eye,compared to 44% of MPS IH/S and 25% of MPS VI patients.In total,16% of MPS IH and 25% of MPS IH/S had severe corneal opacification,compared to 38% of MPS VI patients.16% of MPS IH patients had optic atrophy;21% of MPS VI patients had mild disc swelling,29% had markedly swollen discs,and 14% had optic atrophy.One patient with MPS IH,one with MPS IH/S and six with MPS VI had ocular hypertension.One MPS VI patient had glaucoma that required topical therapy.Nine patients with MPS IH had electrodiagnostic evidence of retinopathy,as did one MPS VI patient.Conclusions:Ocular complications causing significant reduction in vision are common in MPS.The majority of MPS I and MPS VI patients have corneal opacification,which can lead to difficulties in diagnosis and monitoring of glaucoma,optic disc changes,and retinopathy.

葡萄膜炎患者白内障摘除联合人工晶体植入术的远期效果

Objective: To investigate the long-term visual results after cataract extract ion in patients with uveitis, and to demonstrate the long-term viability of int raocular lenses. Design: In all, 61 patients (72 eyes), with update clinical exa mination, were retrospectively evaluated. Comparison of preoperative, postoperat ive, and latest visual function including best-corrected Snellen visual acuity, progression of uveitis and its complications, need for postoperative medical or surgical interventions. Results: After a minimum follow-up of 5 years (mean 7 years 7 months), 82%of eyes maintained a visual improvement of two Snellen line s, 74%maintained 6/9 or better, and 14%had 6/18 or worse. The mode acuity was better than 6/6. The prevalence of macular oedema or scarring was 24%, of poste rior capsule opacification 96%, and of glaucoma drainage, 15%. Conclusions: We report the long-term follow-up of cataract extraction and intraocular lens (I OL) implantation performed by a single surgeon on patients with uveitis attendin g a regional tertiary referral uveitis clinic. Using stringent perioperative and postoperative control of inflammation, patients with uveitis usually maintain h igh visual acuity over long-term follow-up. The incidence of sight-threatenin g postoperative complications is low and no ongoing complication has been attrib uted to IOL implantation.

RITE使用Fricke瓣用于眼眶周围重建

Purpose: To revisit an important but outmoded periorbital reconstructive technique. We present cases to illustrate the usefulness of the Fricke flap and describe a method of rapid intraoperative tissue expansion (RITE), which can enhance the applicability and effectiveness of the Fricke flap. A comparison between those cases performedwith andwithout adjunctive RITE was not made due to the low numbers available. Methods: A retrospective review of clinical cases. Results: A total of 20 cases in which the Fricke flap was used for periorbital reconstruction were reviewed. The mean patient age was 64.7 years; the male-to-female ratio was 1:1. The patient follow-up ranged from 1 to 8 years with a mean of 4.2 years. The most common cause (65% ) of periorbital defect was excision of eyelid malignancy. Necrosis of the terminal segment of the flap requiring further surgical intervention occurred in 10% (2/20). In both of these cases, the surgeons were trainees, with the complications being due to poor surgical technique. In the first case, the flap base was too narrow and in the second case, the distal end of the flap was thinned excessively. The functional result was excellent in 10/20 (50% ), good in 5/20 (25% ), fair in 3/20 (15% ), and poor in 2/20 (10% ). The cosmetic result was excellent in 3/20 (15% ), good in 12/20 (60% ), fair in 3/20 (15% ), and poor in 2/20 (10% ). Conclusion: The Fricke flap is an important and, in selected cases, an indispensable technique in periorbital reconstruction.

不同丙烯酸IOL的设计对异常闪光感的影响

Purpose: To compare the incidence and severity of all grades of dysphotopsia in three types of acrylic intraocular lenses: the Acrysof MA30 BA and MA60 BM IOLs (Alcon) and the Akreos Fit one-piece IOL (Bausch and Lomb). Methods: In all 111 patients were prospectively recruited who had undergone uncomplicated cataract surgery in the previous 12 months. Patients were assessed using a combination of a questionnaire and standardised provocation test, and were scored on a grading scale of 0-6 (0 indicating no glare and 6 indicating the most severe symptoms). Results: The overall incidence of dysphotopsia was 77.7%. Patients with absent or mild symptoms (scoring 2 or less on the grading scale) were greater in the group implanted with the Akreos IOLs (49/65 eyes, 75%) as opposed to (44/92 eyes, 48%) of the eyes implanted with Acrysof lenses. Patients with more marked symptoms of glare as judged by scores of 5-6 were uncommon, but more prevalent in the Acrysof lenses (12/92 eyes, 13%) compared to the Akreos lenses (3/65 eyes, 4.6%) respectively. Statistically the Mann-Whitney test showed that therewas significantly less dysphotopsia with the Akreos lens when compared to the Acrysof MA30 (P=0.005) and MA60 lenses (P=0.002). Conclusion: This study demonstrates that dysphotopsia symptoms are commonly seen in certain brands of Acrylic IOLs. However, differences in design (not only related to the edge) significantly reduce the incidence of moderate and severe grades of dysphotopic symptoms.

青光眼多焦视诱发电位和SITA标准视野检查的测试-再测试变异性研究

PURPOSE. To investigate the test- retest variability of multifocal visual evoked potential (mfVEP) and threshold perimetry in glaucoma, and to examine the relationship between the two techniques. METHODS. Data were recorded using the AccuMap mfVEP and SITA standard program of the Humphrey Field Analyzer. Data were obtained twice within a 4- week period from both eyes of 74 patients with varying amounts of glaucomatous visual field loss. The number of defective test locations (those falling beyond a given probability value of being normal) were calculated for mfVEP and SITA, using databases incorporated within the instruments software. Reliability measures and test times were recorded along with patient test preference. RESULTS. Both tests showed a large degree of test- retest variability in the number of defective test locations (95% limits of agreement for mfVEP and SITA being 13.39 and 9.88, respectively). A “ fair to moderate” degree of spatial agreement was found between mfVEP and SITA. The number of mfVEP defective locations was dependent on the signal amplitude. No relationship was found between test- retest variability and the reliability indices for either test. The mean time taken to perform mfVEP and SITA standard was 33 and 20 minutes, respectively, and 73 of the 74 patients preferred the mfVEP test. CONCLUSIONS. Test- retest variability was found to be slightly greater for mfVEP. The processing of mfVEP signals needs to be changed to remove the relationship between the number of defective locations and signal amplitude. The majority of patients preferred mfVEP to conventional perimetiy although mfVEP takes longer to perform.

Mansonella ozzardi parasitic infestation in the orbit

Mansonella ozzardi, one of many filarial nematodes exclusively found in parts of Latin America, is one of two Mansonella sp which cause mansonelliasis, an infestation first described by Sir Patrick Manson, the founder of the field of tropical medicine.