Objective: The aim was to formulate clinical practice guidelines for acromegaly. Participants: The Task Force included a chair selected by the Endocrine Society Clinical Guidelines Subcommittee (CGS), five experts in the field, and a methodologist. The authors received no corporate funding or remuneration. This guideline is cosponsored by the European Society of Endocrinology. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. The Task Force reviewed primary evidence and commissioned two additional systematic reviews. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society and the European Society of Endocrinology reviewed drafts of the guidelines. Conclusions: Using an evidence-based approach, this acromegaly guideline addresses impor...

/pdf/acromegaly-an-endocrine-society-clinical-practice-guideline-21g8xh5e8c.pdf

Acromegaly: An Endocrine Society Clinical Practice Guideline

Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM). It has long been recognized as a microvascular disease. The diagnosis of DR relies on the detection of microvascular lesions. The treatment of DR remains challenging. The advent of anti-vascular endothelial growth factor (VEGF) therapy demonstrated remarkable clinical benefits in DR patients; however, the majority of patients failed to achieve clinically-significant visual improvement. Therefore, there is an urgent need for the development of new treatments. Laboratory and clinical evidence showed that in addition to microvascular changes, inflammation and retinal neurodegeneration may contribute to diabetic retinal damage in the early stages of DR. Further investigation of the underlying molecular mechanisms may provide targets for the development of new early interventions. Here, we present a review of the current understanding and new insights into pathophysiology in DR, as well as clinical treatments for DR patients. Recent laboratory findings and related clinical trials are also reviewed.

https://www.mdpi.com/1422-0067/19/6/1816/pdf/1

Diabetic Retinopathy: Pathophysiology and Treatments.

Natural food products have been used for combating human diseases for thousands of years. Naturally occurring flavonoids including flavones, flavonols, flavanones, flavonols, isoflavones and anthocyanidins have been proposed as effective supplements for management and prevention of diabetes and its long-term complications based on in vitro and animal models. To summarize the roles of dietary flavonoids in diabetes management and their molecular mechanisms. Tremendous studies have found that flavonoids originated from foods could improve glucose metabolism, lipid profile, regulating the hormones and enzymes in human body, further protecting human being from diseases like obesity, diabetes and their complications. In the current review, we summarize recent progress in understanding the biological action, mechanism and therapeutic potential of the dietary flavonoids and its subsequent clinical outcomes in the field of drug discovery in management of diabetes mellitus.

/pdf/antidiabetic-properties-of-dietary-flavonoids-a-cellular-2luv8ypf1z.pdf

Antidiabetic properties of dietary flavonoids: a cellular mechanism review

Purpose:To update the 2008 International Classification of Corneal Dystrophies (IC3D) incorporating new clinical, histopathologic, and genetic information.Methods:The IC3D reviewed worldwide peer-reviewed articles for new information on corneal dystrophies published between 2008 and 2014. Using this

/pdf/ic3d-classification-of-corneal-dystrophies-edition-2-1w48wshenu.pdf

IC3D Classification of Corneal Dystrophies—Edition 2

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by production of numerous antibodies that may affect multiple organ systems. Wide variety of systemic features of SLE are attributed to antibodies against the components of cell nuclei. Many of the clinical features, like nephritis and arthritis are due to deposition of immune complexes resulting in tissue damage. Other features of the disease such as hemolytic anemia, thrombocytopenia is due to direct effect of autoantibodies. The ocular manifestations of SLE include lid dermatitis, keratitis, scleritis, secondary Sjogrens syndrome, retinal and choroidal vascular lesions and neuroophthalmic lesions. Keratoconjunctivitis sicca is the most common ocular manifestation, but visual morbidity is usually due to retinal and neuro-ophthalmic manifestations of the disease. Ocular involvement may precede systemic onset of the disease. Early recognition of ocular disease by an ophthalmologist may prevent not only the blinding complications of SLE but also alert the clinician to the likely presence of disease activity elsewhere and timely institution of systemic therapy.

https://www.longdom.org/open-access/ocular-manifestations-of-systemic-lupus-erythematosus-2155-9899.1000191.pdf

Ocular Manifestations of Systemic Lupus Erythematosus

This study evaluated the macular ganglion cell–inner plexiform layer (GC-IPL) thickness using spectral-domain (SD) optical coherence tomography (OCT) in patients with chronic exposure to hydroxychloroquine (HCQ). A total of 90 patients (90 eyes) treated with HCQ for at least 5 years and normal controls were included in the study. A fundus examination, automated threshold perimetry, and GC-IPL thickness measurements using the Cirrus high-definition OCT ganglion cell analysis algorithm were performed in all patients treated with HCQ. Average, minimum, and sectorial macular GC-IPL thicknesses were compared between the patients and controls. There was no statistically significant difference in age or sex between the groups. The anterior segment and fundoscopy were normal in all patients and controls. Visual field (VF) testing was normal in all patients. The average, minimum, and sectorial macular GC-IPL thicknesses were significantly lower in patients than those in control subjects. There was significant thinning of the macular GC-IPL in the absence of clinically evident HCQ-related retinopathy and VF abnormalities. Measurements of the macular GC-IPL thickness using SD-OCT may therefore be useful in the early diagnosis and in monitoring the progression of retinal changes in patients receiving long-term HCQ therapy.

Macular ganglion cell-inner plexiform layer thickness for detection of early retinal toxicity of hydroxychloroquine.

Purpose. To evaluate the tear function tests in patients with Hashimoto's thyroiditis and to compare the results with healthy subjects. Methods. A hundred and ten patients with Hashimoto's thyroiditis and 100 healthy subjects were included in this study. The presence of thyroid-associated ophthalmopathy and tear function tests were evaluated clinically. The results were first compared between the patients and the control groups and then compared between patients with NOSPECS and patients without NOSPECS. Logistic regression analyses of the risk factors for dry eye including sex, gender, free plasma thyroxine, proptosis, upper eyelid margin-reflex distance, and duration of the disease were also evaluated. Results. The mean ocular surface disease index score was significantly higher and mean Schirmer and mean tear break-up time scores were significantly lower in patients compared to control subjects. Mean Schirmer and tear break-up time scores were found to be significantly lower in patients with NOSPECS when compared to the patients without NOSPECS. Both proptosis and free plasma thyroxine levels were significantly associated with dry eye. Conclusions. Patients with Hashimoto's thyroiditis tend to develop dry eye more common than healthy subjects. Proptosis and lower free plasma thyroxine levels were found to be risk factors for the presence of dry eye.

/pdf/presence-of-dry-eye-in-patients-with-hashimoto-s-thyroiditis-3m51e39kys.pdf

Presence of Dry Eye in Patients with Hashimoto's Thyroiditis

Objectives. This study compared the macular and retinal nerve fibre layer (RNFL) thicknesses and optic nerves of eyes with reduced vision due to anisometropia with the contralateral healthy eyes in adults using optical coherence tomography (OCT). Methods. This cross-sectional study was conducted in Ataturk State Hospital, Sinop, Turkey. Macular and RNFL thicknesses, optic nerve disc area, cup area, and horizontal and vertical cup-to-disc ratios obtained using a NIDEK RS-3000 SLO spectral domain OCT device were compared between the amblyopic and fellow eyes in 30 adults with anisometropic amblyopia 18–55 years old who were seen in our clinic with unilateral poor vision. Results. The mean macular thickness was 266.90 ± 23.22 µm in the amblyopic eyes and 263.90 ± 22.84 µm in the fellow eyes, and the mean RNFL thickness was 111.90 ± 12.9 and 109.70 ± 9.42 µm, respectively. The two thicknesses did not differ significantly between the amblyopic and fellow eyes. There were also no significant differences between the eyes in disc area, cup area, and horizontal-vertical cup/disc ratios. Conclusion. There does not seem to be a difference in macular thickness, peripapillary RNFL, or optic disc structures between the amblyopic and fellow eyes in adults.

/pdf/retinal-nerve-fibre-layer-and-macular-thicknesses-in-adults-55wt2f2rga.pdf

Retinal Nerve Fibre Layer and Macular Thicknesses in Adults with Hyperopic Anisometropic Amblyopia.

Purpose:
Describing the ophthalmic findings of an exudative vasculopathy called as Coats-like retinitis pigmentosa on three patients. The etiology of the Coats-like retinitis pigmentosa is obscure. The principal theories have been discussed in this article.

Coats-like retinitis pigmentosa: Reports of three cases

The purpose of this study was to determine whether α-lipoic acid and fisetin have protective effects against cataract in a streptozotocin-induced experimental cataract model. Twenty-eight male BALB/C mice were made diabetic by the intraperitoneal administration of streptozotocin (200 mg/kg). Three weeks after induction of diabetes, mice were divided randomly into 4 groups in which each group contained 7 mice; fisetin-treated group (group 1), α-lipoic acid-treated group (group 2), fisetin placebo group (group 3), α-lipoic acid placebo group (group 4). Fisetin and α-lipoic acid were administered intraperitoneally weekly for 5 weeks. Cataract development was assessed at the end of 8 weeks by slit lamp examination, and cataract formation was graded using a scale. All groups developed at least grade 1 cataract formation. In the fisetin-treated group, the cataract stages were significantly lower than in the placebo group (p = 0.02). In the α-lipoic acid-treated group, the cataract stages were lower than in the placebo group but it did not reach to a significant value. Both fisetin and α-lipoic acid had a protective effect on cataract development in a streptozotocin-induced experimental cataract model. The protective effect of fisetin appears as though more effective than α-lipoic acid.

Effects of two antioxidants; α-lipoic acid and fisetin against diabetic cataract in mice

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