Allergic diseases of the eye.

The prevalence of ocular allergy is clearly underappreciated; it has been an underdiagnosed and undertreated area in primary care medicine. The ocular symptoms associated with the most common ocular allergy conditions,such as seasonal and perennial AC, are twice as likely to affect the allergy sufferer as nasal symptoms alone. The emergence of new medications for the specific treatment of ocular symptoms over the course of the past 15 years offers a new field for improved patient care by the primary and sub-specialty health care providers.

[Immunomodulatory therapy of autoimmune diseases : Quo vadis?]. / Immunmodulatorische Therapie bei Autoimmunerkrankungen : Quo vadis?

Immunomodulatory therapy is the gold standard in the treatment of autoimmune diseases. Increasing knowledge of the underlying mechanisms leading to autoimmunity enables patients to be treated with better and more specific therapies apart from the classical therapies, such as antimalarial drugs and glucocorticoids. For patients this nowadays means a great chance to receive optimized therapy. Numerous treatment options have been developed over the last decades and the development of new treatment approaches and strategies is still ongoing. This review gives an overview of immunomodulatory therapy approaches.

Ocular Involvement in Systemic Autoimmune Diseases.

Eye involvement represents a common finding in patients with systemic autoimmune diseases, particularly rheumatoid arthritis, Sjogren syndrome, seronegative spondyloarthropathy, and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The eye is a privileged immune site but commensal bacteria are found on the ocular surface. The eye injury may be inflammatory, vascular or infectious, as well as iatrogenic, as in the case of hydroxychloroquine, chloroquine, corticosteroids, and bisphosphonates. Manifestations may affect different components of the eye, with episcleritis involving the episclera, a thin layer of tissue covering the sclera; scleritis being an inflammation of the sclera potentially leading to blindness; keratitis, referring to corneal inflammation frequently associated with scleritis; and uveitis as the inflammation of the uvea, including the iris, ciliary body, and choroid, subdivided into anterior, posterior, or panuveitis. As blindness may result from the eye involvement, clinicians should be aware of the possible manifestations and their management also independent of the ophthalmologist opinion as the therapeutic approach generally points to the underlying diseases. In some cases, the eye involvement may have a diagnostic implication, as for episcleritis in rheumatoid arthritis, or acute anterior uveitis in seronegative spondyloarthritis. Nonetheless, some conditions lack specificity, as in the case of dry eye which affects nearly 30 % of the general population. The aim of this review is to elucidate to non-ophthalmologists the major ocular complications of rheumatic diseases and their specific management and treatment options.

The incidence of ophthalmopathy after radioiodine therapy for Graves' disease: prognostic factors and the role of methimazole.

Radioactive iodine-131 (RAI) has been reported to be associated with a high incidence of development or exacerbation of Graves' ophthalmopathy (GO). This is thought to be associated with a surge of autoantibodies after RAI therapy. The role of methimazole (MMI), which possesses immunomodulatory action, in the prevention of GO was explored by studying 114 patients with Graves' disease. They were assigned randomly to receive either RAI alone or adjunctive antithyroid drugs, which consisted of MMI and L-T4 as a block-replacement therapy for 12 months and were followed for 2 yr. Thirty-five patients (30.7%) had GO at presentation. Twenty-one (18%) patients developed new GO, and six had worsening of preexisting GO. The development of hypothyroidism (P < 0.01) and an elevation of TSH (P < 0.05) were associated with increased risk of development or exacerbation of GO. The chance of development or exacerbation of GO is higher in those with no ophthalmopathy than in those with preexisting GO at presentation (P = 0.002). The incidence of development or exacerbation of GO was similar in the two treatment groups (RAI, 22.8%; adjunctive antithyroid drugs, 23.7%; P = NS). MMI was able to suppress the surge of TSH receptor antibody (TRAB) after RAI, but a surge in TRAB was not of prognostic significance for the development of GO after RAI. Patients who developed or had exacerbation of GO actually had lower TRAB at presentation (P = 0.02). We conclude that hypothyroidism with elevated TSH is an important adverse factor for the development or exacerbation of GO, and MMI was unable to prevent the development or exacerbation of GO after RAI.

Immunomodulatory therapy for anterior segment ocular inflammation.

PURPOSE OF REVIEW: To outline immunomodulatory therapy for ocular inflammatory diseases of the anterior segment and to review the current literature regarding their efficacy and safety. RECENT FINDINGS: Most current studies concern immunomodulatory treatment of patients who have chronic, debilitating disease resistant to corticosteroids. The authors evaluated the efficacy of treatment, the side effect profiles and the potential for long-term remission. SUMMARY: Immunomodulatory drugs are increasingly being used in ocular inflammatory disease to avoid the effects of chronic steroid therapy and to induce remission in patients with chronic disease. These therapies have shown efficacy in treating otherwise resistant disease with relative safety insofar as side effects are generally reversible and medications can be substituted if intolerable side effects arise. Future trends in treatment will emphasize more specific target molecules, less immunosuppressive drugs and modification of the immune environment to increase the rates of long-term remission.

[Titers of antibodies against thyroid membrane antigens in patients with Graves-Basedow disease and progressive infiltrative ophthalmopathy during treatment with glucocorticoids and retro-orbital tissue irradiation]. / Miano przeciwcial przeciw antygenom blon komórek tarczycy u chorych na chorobe Gravesa-Basedowa i postepujaca oftalmopatie obrzekowo-naciekowa w przebiegu leczenia glikokortykoidami i napromienianiem tkanki pozagalkowej.

In 22 patients with progressive endocrine ophthalmopathy (classes 4-6 according to Werner's scale and ophthalmopathy index at least 4 and evidences of infiltrative changes in retro-ocular tissues in computerised tomography, after achievement of euthyroid state) the titers of antibodies against thyroid membrane antigens (ATMA) were determined by Gardas and all. method. Control group consisted of 26 patients with Graves-Basedow disease without clinical signs of ophthalmopathy who were investigated for ATMA before and after conventional methimazole treatment. The determinations of ATMA were performed before treatment, after 3-4 weeks and subsequently once a month. ATMA's titers exceeding 1:1000 were found in 68% of patients with progressive infiltrative ophthalmopathy and in 77% of patients with Graves-Basedow disease without ophthalmopathy. The incidence of elevated ATMA titers during treatment of ophthalmopathy with supervoltage retro-orbital tissues irradiation with high dose of prednisone, decreased markedly in 6th month of treatment with subsequent increase to average 55% at the end of treatment what suggests the influence of therapy on antibodies production. The changes in the incidence of elevated ATMA titers during conventional Graves-Basedow disease treatment were different. No relations between increased ATMA titers and intensity of infiltrative ophthalmopathy and the course of treatment in the patients with ophthalmopathy were found.