Proliferative vitreoretinopathy: A new concept of disease pathogenesis and practical consequences.

Background: Graves' ophthalmopathy (GO) significantly impairs the quality of life of affected individuals and the most severe cases can be sight threatening. Given the limited therapeutic options, a strong emphasis should be placed on disease prevention to diminish the significant morbidity associated with this disease. Summary: GO is most prevalent in women and most severe in men. Although some genetic differences between GO patients and Graves' disease patients without ophthalmopathy have been identified, none of the polymorphisms identified to date impart a high enough risk of GO to justify genetic testing to guide therapy or preventive strategies. Poorly defined mechanical factors that appear also to play a role in GO susceptibility will likely be better elucidated with advances in imaging techniques. Tobacco smoking has been consistently linked to development or deterioration of GO. Smokers who receive radioactive iodine have the highest incidence of unfavorable GO outcome, which is proportional to t...

Risk factors for development or deterioration of Graves' ophthalmopathy.

Epidemiology of Graves' orbitopathy (GO) and relationship with thyroid disease

Proliferative vitreoretinopathy is a disease process that follows the proliferation of ectopic cell sheets in the vitreous and/or periretinal area, causing periretinal membrane formation and traction, in patients with rhegmatogenous retinal detachments. Currently, vitreous surgery is the standard treatment; however, the results aren’t satisfactory given the vision loss that ensues and that redetachment is relatively common. It is becoming clearer that there exists an interplay between various cytokines/growth factors, matrix proteins, and the different cell types that drive the undesirable formation of periretinal membranes. This fundamental understanding is aiding in identifying different adjunct agents that can block the cellular events intrinsic to proliferative vitreoretinopathy. In this review, we describe the current understanding on the pathogenesis and discuss how the fundamental understanding of the biochemical/molecular events is instrumental in developing the novel treatment strategies that are also highlighted.

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Proliferative vitreoretinopathy: current and emerging treatments.

Thyroid-associated ophthalmopathy is the most frequent extrathyroidal involvement of Graves' disease but it sometimes occurs in euthyroid or hypothyroid patients. Thyroid-associated ophthalmopathy is an autoimmune disorder, but its pathogenesis is not completely understood. Autoimmunity against putative antigens shared by the thyroid and the orbit plays a role in the pathogenesis of disease. There is an increased volume of extraocular muscles, orbital connective and adipose tissues. Clinical findings of thyroid-associated ophthalmopathy are soft tissue involvement, eyelid retraction, proptosis, compressive optic neuropathy, and restrictive myopathy. To assess the activity of the ophthalmopathy and response to treatment, clinical activity score, which includes manifestations reflecting inflammatory changes, can be used. Supportive approaches can control symptoms and signs in mild cases. In severe active disease, systemic steroid and/or orbital radiotherapy are the main treatments. In inactive disease with proptosis, orbital decompression can be preferred. Miscellaneous treatments such as immunosuppressive drugs, somatostatin analogs, plasmapheresis, intravenous immunoglobulins and anticytokine therapies have been used in patients who are resistant to conventional treatments. Rehabilitative surgeries are often needed after treatment.

Thyroid-associated Ophthalmopathy.

PURPOSE. The frequency of childhood Graves’ disease (GD) in Hong Kong Chinese is among the highest in the world but childhood Graves’ ophthalmopathy (GO) appears to have milder clinical severity than does the adult disease. This study was conducted to investigate CTLA-4 and IL-13 polymorphisms in Chinese pediatric patients with GD and GO. METHODS. Recruited for the study were 177 childhood patients with GD (age range, 2–16 years) and 151 unrelated control subjects (age range, 4 –16 years) for genotype analysis of IL-13 single-nucleotide polymorphisms (SNPs) (1112C/T and 2044G/A), CTLA-4 SNPs (318C/T, 49A/G, and CT60A/G), and the repeat length of (AT)n in the 3 untranslated region (UTR) of CTLA-4. RESULTS. The patients with GD revealed higher frequencies of CTLA-4 49 GG genotype and G alleles than did the control subjects (P 0.005 and P 0.03, respectively). The CT60 GG genotype and G alleles were more prevalent in GD (P 0.07 and P 0.02, respectively). The CTLA-4 SNPs (318C/T, 49A/G, and CT60A/G) were in the same haplotype block, and the CGG haplotype was associated with GD (P 0.0071) but not GO. The shortest allele of (AT)n was protective against GD

Association of CTLA-4 and IL-13 gene polymorphisms with Graves' disease and ophthalmopathy in Chinese children.

Purpose:To evaluate the midterm anatomical and functional outcomes of intravitreal injection of low-dose triamcinolone acetonide in silicone oil-filled eyes as an adjunctive treatment for proliferative vitreoretinopathy.Methods:This is a retrospective interventional case series. Patients with prolif

Midterm results of low-dose intravitreal triamcinolone as adjunctive treatment for proliferative vitreoretinopathy.

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Association of CTLA-4 and IL-13 gene polymorphisms with Graves' disease and ophthalmopathy in Chinese children.

Midterm results of low-dose intravitreal triamcinolone as adjunctive treatment for proliferative vitreoretinopathy.